The Application Value Of Related Serological Indexes In Early RA

Objective:By detecting the levels of 15 related serological indexes in early rheumatoid arthritis(early RA),evaluate the better diagnostic performance indexes,and to explore the best mathematical diagnostic model used in the diagnosis of early RA,improve the diagnosis rate of early RA,avoid blind and repeated development of detection in laboratory and clinical;By analyzing the correlation between 15 indexes and the pathological features of patients with early RA,to evaluate the better indicators for assessing disease activity and prognosis,provide reference for clinic.Methods:There were 140 cases in the early RA group,120 in the non-RA group,and 100 in the healthy control group.The subjects of the early RA and non-RA groups were from the patients who were treated at the Department of Rheumatology and Immunology of Yuxi City People's Hospital from September 2015 to October 2016,and met the diagnostic criteria of RA as revised by the American College of Rheumatology(ACR),Non-RA group were also confirmed by clinical,selected the people in the same period who had physical examination in the Yuxi City People's Hospital physical examination center as healthy control group;Collected clinical data of early RA patients.1.Immunotransmittance turbidimetry was used to detect C-reactive protein(CRP),rheumatoid factor(RF),erythrocyte sedimentation rate(ESR)was measured by automatic blood sedimentation apparatus,anti-keratin antibodies(AKA),anti-nuclear antibody(ANA),anti-perinuclear factor antibody(APF)were detected by indirect immunofluorescence,anti-mutant citrullinated vimentin(MCV)antibody,glucose 6 phosphate isomerase(GPI),anti-cyclic citrullinated peptide(CCP)antibody,tumor necrosis factor-a(TNF-a),interleukin-1(IL-1),interleukin-17(IL-17),interferon-?(IFN-y)were detected by enzyme-linked immunosorbent assay,interleukin-6(IL-6)was detected by electrochemiluminescence immunoassay,25-hydroxyvitamin D(25-OH-VD)was detected by chemiluminescence immunoassay.2.By comparing the levels of 15 indexes in each group,indicators which were no statistical significant would be removed.3.The remaining indexes were used as ROC curve to determine the AUC>0.75 indexes.4.The indexs which were selected out would be clarified the obvious related items by using the two-variable correlation analysis,obviously correlation indexs to choose the AUC bigger.5.Evaluated diagnostic performance of single index item in early RA.6.The selected indicators were modeled according to different mathematical permutations and combinations,evaluated the mathematical model with the best diagnostic performance in early RA and verified the model7.Spearman rank correlation analysis and pearson single factor correlation analysis were used to explore the correlation between each index and the pathological features of early RA patients(DAS28 score,X-ray stage,external manifestations of the joints),the indexes with better performance in evaluating disease activity and prognosis were selected out.Results:1.Among the 15 indexes,in addition to IL-1,IL-17,IFN-y,25-OH-VD were not statistical significance in the early RA group and the non-RA group,the remaining indexes were lower in the healthy control group and non-RA group than in the early RA group,and the differences were statistically significant(P<0.05).2.The ROC curve showed that RF,anti-CCP,CRP,GPI,MCV,TNF-? and IL-6 had better diagnostic performance in early RA,AUC>0.75.3.The seven indexes with better diagnostic performance were analyzed by a two-variable correlationcan be divided into four groups:(1)RF independent correlation;(2)GPI independent correlation;(3)anti-CCP antibody,anti-MCVantibody significantly related;(4)CRP,TNF-?,IL-6 significantly related.A better diagnostic performance index was selected from each group,which was RF,GPI,anti-CCP antibody,IL-6.4.When RF,GPI,anti-CCP,IL-6 were respectively used in the diagnosis of early RA,the highest sensitivity was RF,but the specificity was lower,the highest specificity was anti-ccp,but its sensitivity was not good.there were defects in single test,and had a certain rate of missed diagnosis.5.Established mathematical diagnostic model of RF,GPI,anti-CCP antibody,IL-6,the largest AUC was the model of 11,with the best diagnostic performance.6.It was proved that the largest area under the curve was the model 11,which had the best diagnostic performance and repeatability.7.Among the 15 indexes,the indexes that positively correlated with DAS28 score,X-ray stage and extra-articular manifestations of the joints of early RA patients were anti-CCP,TNF-?,IL-17,they can be used to evaluate the disease activity and prognosis of early RA patients,anti-CCP antibody and IL-17 were significantly related,choose one of them.Conclusion:1.The diagnostic performance of RF,anti-CCP,CRP,GPI,MCV,TNF-a and IL-6 was better,obviously related items,choose one of them,avoid laboratory blind and repeated testing.2.The diagnostic efficiency of early RA can be significantly improved with the establishment of a mathematical diagnostic model.3.Anti-CCP antibody,TNF-a and IL-17 were significantly correlated with the pathological features of early RA patients,can be used as an optimal index to evaluate the condition of RA patients.