| Objective: to detect the level of serum homocysteine in patients with rheumatoid arthritis,analyze the relationship between Hcy and clinical data and laboratory indexes of patients with RA,and explore the clinical application value of serum homocysteine in patients with rheumatoid arthritis,so as to provide some new ideas for the diagnosis and treatment of clinical RA.Methods: 193 patients with rheumatoid arthritis admitted in the Department of Rheumatology and Immunology,second Hospital of Lanzhou University from2018.01 to 2020.10 were collected.Enzyme-linked immunosorbent assay(ELISA)was used to compare the difference of serum homocysteine level between them and157 healthy subjects who were examined in the physical examination center of our hospital in the same period.The Hcy levels of patients with RA were compared among different genders,different ages,different course of disease and disease activity.The relationship between the level of serum homocysteine and the clinical data and laboratory indexes of RA in patients with RA was analyzed.Including age,course of disease,number of joint swelling,number of joint tenderness,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),anti-cyclic citrullinated antibody(ACPA)),rheumatoid factor(RF),triglyceride(CHO),cholesterol(TG),high density lipoprotein cholesterol(HDL),low density lipoprotein cholesterol(LDL),28 joints disease activity score(DAS28 score).SPSS 25.0 statistical software was used for data statistics and analysis.Results:1.The level of serum homocysteine in patients with RA was significantly higher than that in healthy controls [14.0(11.0,18.0)μmol/L VS 11.6(9.6,13.7)μmol/L,P<0.001].2.The level of serum Hcy in RA male group was significantly higher than that in female group [17.0(14.0,23.0)μmol/L VS 12.6(10.0,16.0)μmol/L,P<0.001].3.Serum homocysteine levels in young,middle-aged and old patients with RA were compared between the two groups [13.0(10.0,16.0)μmol/L VS 14.0(11.0,17.0)μmol/L;14.0(11.0,17.0)μmol/L VS 14.0(12.0,19.9)μmol/L.The level of serum Hcy in middle-aged and old RA patients was higher than that in young RA patients,but the difference was not statistically significant(P>0.05).The level of serum Hcy in middle-aged and elderly RA patients was higher than that in young RA patients,but the difference was not statistically significant.0.1640.01056(P > 0.05).4.Comparison of serum homocysteine among the early,middle and late stage groups of RA patients [14.0(10.0,19.0)μmol/L VS 14.0(12.0,17.0)μmol/L;14.0(10.0,19.0))μmol/L VS 12.0(10.0,16.0)μmol/L;14.0(12.0,17.0)μmol/L VS 12.0(10.0,16.0)μmol/L].There was significant difference in serum Hcy level between RA patients during the middle and late stages of disease(P=0.027,P<0.05).Hcy level was not significantly different between early and middle stage,early and late stage of RA(P=0.496;P=0.113,P>0.05).5.There was no significant difference in serum Hcy levels among the four groups of RA patients in stable stage,mild disease activity group,moderate disease activity group and severe disease activity group(P=0.851,P>0.05).6.The level of serum Hcy in patients with RA was correlated with ACPA(r=0.165,P=0.022)and RF-Ig G(r=0.194,P=0.075),but the correlation coefficient was less than 0.3.There was no correlation between serum Hcy with the number of tenderness joints(r=-0.21,P=0.073),the number of swollen joints(r =-0.21,P=0.776),ESR(r=-0.009,P=0.902),CRP(r=0.056,P=0.435),the rheumatoid factor(RF-Ig A(r=0.077,P=0.285),RF-Ig M(r=0.061,P=0.397)),CHO(r=-0.045,P=0.532),TG(r=0.086,P=0.234),HDL(r=-0.117,P=0.104),LDL(r=0.424-0.015,P=0.834)Conclusion:Serum Hcy expression was increased in RA patients.The level of serum Hcy was higher in men than in women,and in patients with mid-stage disease than in late disease.serum Hcy levels in RA patients did not correlate significantly with clinical and laboratory indices such as the number of swollen joints,ACPA,rheumatoid factor.Objective: to explore the significance of homocysteine in RA with bone erosion or combined with osteoarthritis.And to detect the feasibility of serum homocysteine in the diagnosis of bone erosion and osteoarthritis in patients with RA.Methods:(1)A total of 140 RA patients who were admitted to the Department of Rheumatology and Immunology,second Hospital of Lanzhou University from2018.01 to 2020.10 were divided into two groups: RA bone erosion group(n=63)and RA without bone erosion group(n=77),and the differences of serum Hcy and clinical and laboratory indexes between the two groups were compared.The correlation between clinical and laboratory indexes and bone erosion in patients with RA was studied by Logistic regression analysis,and the joint detection factor model of bone erosion was established,and the working characteristic curve(ROC)was drawn.(2)37 patients with RA complicated with osteoarthritis were selected from the Department of Rheumatology and Immunology,the second Hospital of Lanzhou University from 2019.10 to 2020.10,and 42 patients with simple RA and 39 healthy subjects who were admitted to the physical examination center of our hospital in the same period were collected.The differences of serum Hcy level and other clinical and laboratory indexes among the three groups were compared.The joint detection factor model of RA patients with OA was established by Logistic regression analysis,and the working characteristic curve of the subjects was drawn to calculate the predictive value of each index to RA complicated with OA.The collected clinical data were sorted out by SPSS 25.0 software and analyzed by statistical methods.Results:1.the course of disease in RA bone erosion group was significantly higher than that in non-bone erosion group [84.0(36.0,168.0)months VS 36.0(12.0,108.0)months].(2)the level of serum Hcy in RA bone erosion group was significantly higher than that in non-bone erosion group [15.8(12.0,20.0)μmol/L] compared with that in non-bone erosion group [12.0(10.0,16.0)μmol/L],and the difference was statistically significant(P < 0.05).(3)DAS 28 between the bone erosion group and the non-bone erosion group of RA patients,ESR [34.0(21.0,60.0)mm/h VS 31.0(16.0,64.0)mm/h],CRP [19.0(7.28,44.7)mg/L VS 13.6(4.2,40.7)mg/L],ACPA[107.0(21.0,198.0)RU/m L VS 78.0(8.5,200.0)RU/m L].There was no significant difference between the two groups(P > 0.05).2.The sex,age,course of disease,Hcy,ESR,CRP and ACPA of RA patients with and without bone erosion were analyzed by Logistic regression.The results showed that,Hcy(OR=1.067,95%CI:1.008-1.129 was a risk factor for bone erosion in RA.The risk of bone erosion in RA patients with elevated serum Hcy was 1.067 times higher than that in patients without increased bone erosion.The course of disease(OR=1.007,95%CI:1.002-1.012)is a risk factor for bone erosion in RA.The risk of bone erosion in patients with RA is 1.007 times higher than that in early RA.DAS 28score(OR=1.604,95%CI:1.047-2.456)was a risk factor for bone erosion in RA.The risk of bone erosion in patients with RA was 1.604 times higher than that in early RA.The results of other indexes were not statistically significant.3.The predictive value of Hcy,RA course,DAS 28 score and the combination of the three indexes in predicting bone erosion in patients with RA were evaluated by receiver operating characteristic curve((ROC)).When Hcy takes the upper left corner corner 14.15 umol / L,the area under the curve is 0.636(95%CI=0.544-0.729),and the sensitivity and specificity are 60.3% and 67.5%,respectively.When the upper left corner corner was taken for 54 months,the area under the curve was 0.667(95%CI=0.577-0.757).At this time,the sensitivity was 68.3% and the specificity was62.3%.When the DAS 28 score is 4.585,the area under the curve is 0.561(95%CI=0.465-0.657),the sensitivity is 51.6% and the specificity is 66.2%.The area under the ROC curve of Hcy combined with course of disease and DAS 28 score was0.701(95%CI=0.616-0.788).The sensitivity and specificity of detection were 58.7%and 74.0% respectively.4.(1)the level of serum Hcy in rheumatoid arthritis with osteoarthritis(RA+OA)group[17.0(14.0,24.0)μmol/L] was significantly higher than that in RA group[13.0(10.0,16.0)μmol/L] and healthy control group[10.0(9.2,12.5)μmol/L](P <0.05).(2)the level of serum CRP in patients with RA+OA was significantly higher than that in patients with simple RA [29.43(7.8,52.7)mg/L VS 12.0(2.91,32.0)mg/L],which was significantly higher than that in patients with RA alone(P < 0.05).(3)the omparison of disease course[4.5(3.7,5.1)months VS 4.5(3.53,5.29)months,ESR[40.0(17.0,70.5)mm/h VS 42.5(22.0,64.5)mm/h],ACPA[126.0(61.5,200.0)RU/m L VS 83.9(10.0,189.0)RU/m L] were no significant difference between the RA+OA group and the simple RA group(P > 0.05).5.Age,sex,course of disease,ESR,ACPA,Hcy,CRP and other indexes between RA with OA group and RA group were analyzed by Logistic regression.The results showed that,Hcy(OR=1.089,95% CI:1.015-1.170,P=0.018 < 0.05 was a risk factor for RA complicated with OA.The risk of elevated serum Hcy with OA in patients with RA was 1.089 times higher than that in patients without Hcy.There was no correlation between the other indexes and the combination of RA and OA.6.The receiver working characteristic curve(ROC)showed that when the serum Hcy was 15.25 umol / L,the area under the curve was 0.702,the sensitivity was67.6%,and the specificity was 69.0%.Conclusion:1.(1)Serum Hcy,disease duration,and DAS 28 score in RA patients may be associated with the emergence of joint erosion.(2)Serum Hcy,disease duration,and DAS 28 score in RA patients may be used as predictors of the emergence of joint erosion,and the combined predictive value of the three indicators is higher than the three groups of indicators diagnosed independently.2.(1)Serum Hcy may be associated with RA combined with OA.(2)Serum Hcy in RA patients may be used as a predictor of combined OA. |
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