| Background and Objective:Rheumatoid arthritis(RA)is a kind of common auto-immune disease.Its pathological characteristics are the production of autoantibodies and the proliferation of inflammatory mediators which result in the swelling of synovium hyperplasia,the destruction of cartilage and bone and systemic complications including cardiovascular,cerebrovascular,lung,bone and even cognitive and psychological status are affected.On account of a progressive disease in RA,the temporary remission and recurrence of symptoms eventually lead to severe physical and mental disability.Base on the World Health Organization report,the global incidence rate of RA is 1%and mostly female,and has been increasing steadily at all ages.Although in 2010,the American College of Rheumatology(ACR)/the European League Against Rheumatism(EULAR)proposed diagnostic guidelines for RA,but due to the complexity of cases and the multiple difficulties in cross-infection in clinical work,new methods for diagnosing and evaluating RA are highlighted.In recent years,the clinical assessment of RA disease activity is mainly based on the Disease Activity Score of 28 joints(DAS-28)score and the non-specific laboratory indicators including the C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),but sometimes it can not accurately reflect the patient's condition by relying on these indicators.Nowadays,the C-reactive protein to prealbumin ratio(CPR)and prealbumin to fibrinogen ratio(PFR)are two new inflammatory markers which have been proved to be a good disease activity and prognostic indicator for systemic inflammatory diseases and cancers.However,the applied value in early period RA is still unknown.Therefore,the aim of this study is to explore the evaluative and predictive value of CPR and PFR for RA activity and compare CPR and PFR with traditional inflammatory markers which have correlation with RA disease activity including C-reactive protein to albumin ratio(CAR),albumin to fibrinogen ratio(AFR),neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR).Methods:A total of 168 patients diagnosed as early RA in the First Affiliated Hospital of Zhengzhou University and 119 healthy people in hospital were selected as the control group from January 2016 to December 2017.After admission,the basic clinical data of patients and control group were collected.After fasting for 8 hours,peripheral venous blood was collected for blood routine and biochemical index detection.The anti-cyclic citrulline polypeptide antibody(ACPA)was determined by enzyme-linked immunosorbent assay(ELISA),and the rheumatoid factor(RF)was quantitatively detected by rate nephelometry.According to the DAS-28 score,RA patients were divided into active group(120 cases,DAS-28>2.6)and remission group(48 cases,DAS-28<2.6).Spearman's correlations were used to analyze the correlations between CPR,PFR,CAR,AFR,NLR and PLR and disease activity index in RA patients.Receiver-operating characteristic(ROC)curve was used to compare the diagnostic efficacy of the above indexes in RA,and the area under curve(AUC)in CPR,PFR and other inflammatory indexes were compared.Binary logistic regression was used to determine the independent predictors of RA severity.Results:Differences in clinical indicators:CPR,PFR,CAR,AFR,NLR,PLR in RA group are 0.36(0.04-0.79)?45.77±31.50?1.42(0.23-2.46)?9.09±3.48?3.42±2.43?242.11±140.35,CPR,CAR,NLR and PLR were higher than the control group,PFR and AFR were lower than the control group,the difference was statistically significant(P<0.05).In RA patients,CPR,CAR,NLR and PLR in active group were higher than those in remission group,on the other hand,PFR and AFR were lower than those in remission group,the difference was statistically significant(P<0.05).Correlation between CPR and PFR and disease activity of RA:CPR was positively correlated with CRP,ESR and DAS-28(r=0.992,r=0.780,r=0.729,P<0.05),and PFR was negatively correlated with CRP,ESR and DAS-28(r=-0.817,r=-0.805,r=-0.739,P<0.05),moreover the correlation coefficient of CPR and PFR was better than other traditional markers.In addition,RF and ACPA showed no significant correlation with DAS-28,CRP and ESR(P>0.05).Diagnostic efficacy of CPR and PFR:ROC curve analysis showed that the sensitivity(81.87 and 79.44)and specificity(99.17 and 98.21)of AUC(0.938 and 0.921)of CPR and PFR were higher than those of traditional inflammatory indexes,and the difference of AUC was statistically significant(P<0.05).The predictive value of CPR and PFR for RA disease activity:Binary Logistic Regression Analysis showed that CPR was a good predictor of RA severity(OR=2.88,95%CI(1.862-4,814),P=0.024),and PFR was related to the risk reduction of RA disease activity(or=0.77,95%CI(0.741-0.908),P=0.013).Conclusions:As new practical and cheap inflammatory markers,CPR and PFR have a certain clinical value in early evaluation of disease activity and prediction of disease severity,which are superior to traditional inflammatory indicators in RA. |
PDF Full Text Request