| Research Background:Rheumatoid arthritis(RA)is a common chronic autoimmune disease with unclear etiology,and effective drug to completely cure it.Most of the current treatment options for RA require patients to take long-term medication,so early diagnosis and treatment are particularly important.At present,the diagnosis of RA is mainly based on clinical symptoms,imaging diagnosis and classic laboratory indicators,such as rheumatoid factor(RF)and anti-cyclic citrullinated polypeptide antibody(anti-CCP).For some RA patients,clinical symptoms are difficult to distinguish from other bone and joint diseases.In the early stage of disease development,there are no obvious imaging changes in bone and joints and serological indicators are also negative,which can easily lead to missed diagnosis and misdiagnosis,and delay the disease treatment of RA patients.Therefore,it is necessary to find indicators with higher sensitivity and specificity to improve the diagnostic level.Studies have found that serum calprotectin(CLP)and anti-mutated citrullinated vimentin antibody(anti-MCV)are elevated in RA patients,which have certain value for the diagnosis of RA,but the relationship between them and disease activity is relatively low..The Systemic Immune Inflammation Index(SII)is a new inflammatory index,which is calculated by the counts of three inflammatory cells.The calculation formula for SII is neutrophil count multiplied by platelet count divided by lymphocyte count.The system objectively responds to the homeostasis between host inflammatory and immune responses.Studies have found that SII has a certain diagnostic potential in RA,while its relationship with disease activity is lacking.Purpose:To explore the diagnostic efficacy of CLP,anti-MCV and SII in RA patients,and to further study the relationship between CLP,anti-MCV and SII and RA-related diagnostic indicators.Method:A total of 375subjects were included in this study and divided into 3 groups,namely the RA experimental group(183 cases),the non-RA control group(56 cases of osteoarthritis,46 cases of gouty arthritis,and 42 cases of ankylosing spondylitis).),and 48 healthy controls in the same period.The above research subjects were selected from the relevant cases and health check-ups confirmed in the Second Affiliated Hospital of Nanchang University and Yingtan City People’s Hospital from January2020 to June 2021.The following methods were used to determine the relevant indicators for all enrolled patients and health check-up personnel:(1)The serum expression levels of CLP and anti-MCV were detected by enzyme-linked immunosorbent assay(ELISA);(2)Immune turbidimetry was used to detect RF and C-reactive protein(CRP);(3)Latex immunoturbidimetry was used to detect anti-CCP;(4)Wilhelminth’s method was used to detect erythrocyte sedimentation rate(ESR);(5)Detection of platelets in blood by sheath flow impedance method,detection of neutrophils and lymphocytes in blood by three-dimensional analysis of laser light scattering and fluorescence staining and calculation of SII;(6)DAS28 was calculated according to the RA activity score;(7)Draw the receiver operating curve(ROC)to clarify the diagnostic value of CLP,anti-MCV and SII alone and in combination with RF and anti-CCP for RA;(8)Through spearman correlation analysis,the correlation between CLP,anti-MCV and SII and RF,anti-CCP,CRP,ESR and DAS28,respectively,was explored.(9)To study the expression levels of CLP,anti-MCV and SII in different disease activity of RA;(10)The RA group was further divided into RF positive and RF negative groups,and the expression levels of CLP,anti-MCV and SII in different RF groups were analyzed.Result:(1)The level of CLP in RA group,non-RA group and healthy control group were(678.82±214.11)pg/ml,(492.89±204.77)pg/ml and(412.61±140.15)pg/ml,respectively.The RA group was significantly higher than the non-RA group and the Healthy control group(P<0.01),There was no statistical difference between the non-RA group and the healthy control group(P>0.05).The anti-MCV’level in RA group,non-RA group and healthy control group was 286.47(44.96～998.00)U/ml,19.61(10.28～27.02)U/ml and 9.35(3.22～26.59)U/ml,respectively.The RA group was significantly higher than the non-RA group and the healthy control group(P<0.01),and there was no statistical difference between the non-RA group and the healthy control group(P>0.05);The SII’level in RA group,non-RA group and healthy control group was 634.85(486.56～896.14)×10~9/L,553.56(431.77～650.92)×10~9/L and414.29(322.53～492.74)×10~9/L,respectively.There were significant differences between all groups(P<0.01).(2)According to the ROC curve,when the cut off value of CLP is 584.00pg/ml,the sensitivity and specificity for RA diagnosis are 65.7%and 89.7%;when the cut off value of anti-MCV is 34.05U/ml,the sensitivity for diagnosing RA is 80.3%,the specificity was 87.3%;When the cut off value of SII was 502.05×10~9/L,the sensitivity and specificity for diagnosing RA were 73.9%and 77.0%.The diagnosis of RA by CLP,anti-MCV and SII all achieved moderate diagnostic value.The sensitivity and specificity of CLP,anti-MCV and SII combined with RF and anti-CCP for diagnosing RA were further increased.(3)In the correlation analysis,CLP was positively correlated with ESR and DAS28(r=0.251,0.572,P<0.01);anti-MCV was positively correlated with RF and anti-CCP(r=0.408,0.599,P<0.05);SII was positively correlated with anti-CCP,CRP and DAS28(r=0.232,0.433,0.371,respectively.P<0.05).(4)In different disease activities of RA,the expression levels of CLP in high disease activity group,moderate disease activity group and low disease activity group were higher than those in the remission group and healthy control group(P<0.01),and there was a statistical difference between the high disease activity group,the moderate disease activity group and the low disease activity group(P<0.01);The level of anti-MCV in high disease activity group,moderate disease activity group,low disease activity group and remission group was significantly higher than that in healthy control group(P<0.01),the high disease activity group was significantly higher than the remission group(P<0.01),and the moderate disease activity group was higher than the remission group(P<0.05);The expression level of SII in high disease activity group and moderate disease activity group was significantly higher than that in remission group and healthy control group(P<0.01),and the low disease activity group was significantly higher than that in healthy control group(P<0.01).(5)In RF positive group,RF negative group and healthy control group,CLP levels were(714.97±218.37)pg/ml,(577.16±168.98)pg/ml and(412.61±140.15)pg/ml,respectively.The anti-MCV levels were 420.15(37.23～998)U/ml,225.47(96.57～380.22)U/ml and 9.35(3.22～26.59)U/ml;SII levels were 705(516.01～1063.59)×10~9/L,567.74(430.58～679.32)×10~9/L and 414.29(322.53～492.74)×10~9/L.The expressions of CLP,anti-MCV and SII in RF positive group were higher than those in RF negative group and healthy control group(P<0.01);The expressions of CLP,anti-MCV and SII in the RF negative group were higher than those in the healthy control group(P<0.01).Conclusion:(1)The expression levels of CLP,anti-MCV and SII are significantly increased in RA patients,which can be used for the diagnosis of RA patients and the differential diagnosis from non-RA diseases OA,GA and AS.(2)There is a positive correlation between CLP and SII and the clinical disease activity of RA patients,which can be used to monitor the disease activity and evaluate the disease in RA patients.(3)The expression levels of CLP,anti-MCV and SII are increased in RF-negative RA patients,which can assist RF to improve the diagnosis rate of RA patients.It provides new ideas for reducing the missed diagnosis of atypical RA patients.SII is economical and convenient,which is expected to become a new basis for diagnosing RA. |
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