Expression And Clinical Significance Of Heparin-binding Protein In Patients With Rheumatoid Arthritis

Objectives.To explore the expression of plasma heparin-binding protein(HBP)in patients with rheumatoid arthritis(RA)and its significance in the course of RA,and further explore its clinical diagnostic value.Methods.1.A total of 187 RA patients and 60 healthy individuals who were admitted to Zibo First Hospital from January 2021 to July 2022 were collected as research objects.The patients were divided into 3 groups,49 cases of RA complicated with bacterial infection group,73 cases of RA active stage group and 65 cases of RA remission stage group.HBP,C-reactive protein(CRP)and serum amyloid A(SAA)were determined by immunoturbidimetry,interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)and procalcitonin(PCT)were determined by chemiluminescence method,white blood cell(WBC)and cluster of differentiation antigen 64(CD64)in peripheral blood mononuclear cells were determined by flow cytometry,and erythrocyte sedimentation rate(ESR)was determined by Westergren method,observe the differences in the expression of each group of indicators.To evaluate the correlation of HBP with IL-6,TNF-α,SAA,PCT,WBC,ESR and CRP,peripheral blood mononuclear cell CD64,RA disease activity(DAS28)and disease course in RA patients.The changes of various inflammatory indexes and the expression levels of HBP in different types of bacterial infection were observed before and after treatment in the RA complicated with bacterial infection group.DAS28 was used to evaluate the disease activity of the active RA group,and the expression of each inflammatory index in RA with different disease activity was compared.The Kruskal-Wallis H test was used to compare the different groups and the Wilcoxon signed-rank analysis was used to compare the data before and after treatment in the RA combined bacterial infection group.Correlation analysis was performed using Spearman.2.The receiver operating characteristic(ROC)curve of each inflammatory index was drawn by SPSS22.0 software.Med Calc software was used to calculate the Youden index,optimal threshold,sensitivity and specificity of each inflammatory index for differential diagnosis of active RA and patients with bacterial infection and the area under the curve(AUC)differences between HBP and other inflammatory indexes were compared to evaluate the diagnostic efficacy.Results 1.Changes of HBP expression in each group:(1)The HBP in the RA complicated with bacterial infection group and the active group was higher than that in the remission group and the healthy control group(P<0.01),and the HBP in the RA complicated with bacterial infection group was higher than that in the active group(P<0.01),there was no significant difference in HBP between the RA remission group and the healthy control group(P=1.00).(2)The HBP of patients with RA with severe disease activity was higher than that of patients with RA with moderate and mild disease activity(P<0.01),and the HBP of patients with RA with moderate disease activity was higher than that of patients with RA with mild disease activity(P<0.01).(3)There was no significant difference in HBP between RA complicated with Gram-negative and Gram-positive bacterial infection groups(P>0.05).There was no significant difference in HBP between RA complicated with single infection and mixed infection(P>0.05).After antibiotic treatment,the expression of HBP decreased in the RA complicated with bacterial infection group(P<0.01).2.Correlation:(1)In the active RA group,HBP was associated with CRP,DAS28,SAA,ESR,CD64 expression in monocytes,IL-6,TNF-α(P<0.01),but was not significantly associated with PCT,WBC and course of disease(P>0.05).(2)In RA complicated with bacterial infection group,HBP level was correlated with CD64 expression,CRP,TNF-α,IL-6 and SAA(P<0.05),but not with PCT,WBC,ESR and disease course(P>0.05).3.The diagnostic value of HBP for RA:(1)When the HBP level was 24.30ng/m L,the sensitivity of diagnosing RA complicated with bacterial infection was 93.88%,and the specificity was 89.04%,the AUC of HBP differential diagnosis of RA complicated with bacterial infection group and active phase group was significantly higher than that of IL-6,TNF-α,CRP,SAA,PCT,WBC,ESR,and the difference was statistically significant(P<0.05).(2)When the HBP level was11.50ng/m L,the sensitivity and specificity of diagnosing active RA was 100.00% and95.38%.The AUC of HBP in differential diagnosis of RA in active stage group and remission stage group was significantly higher than TNF-α,PCT,WBC,the difference was statistically significant(P<0.05),and there was no statistical difference compared with IL-6,CRP,SAA,ESR significance(P>0.05).Conclusion 1.HBP can reflect the disease activity of RA patients to a certain extent,and is a good biomarker for predicting RA disease activity.2.The level of HBP in patients with active RA is positively correlated with DAS28,monocyte CD64,IL-6,and TNF-α,which may be involved in the occurrence and development of RA inflammation and is expected to become a new target for RA treatment.3.HBP has high value in the differential diagnosis and curative effect monitoring of RA complicated with bacterial infection,RA active stage and remission stage,and its dynamic monitoring is beneficial to the patient’s condition assessment.