可溶性白细胞介素2受体α链的检测与类风湿关节炎疾病活动性评估

doi:10.19723/j.issn.1671-167X.2018.06.006

摘要/Abstract

摘要：

目的: 评价血清可溶性白细胞介素2受体α链(sIL-2Rα、sCD25)对类风湿关节炎(rheumatoid arthritis,RA)活动度评估的临床意义。方法: 收集RA患者血清108例,RA关节液标本40例,骨关节炎(osteoarthritis,OA)患者血清39例,健康人血清50例,采用酶联免疫吸附(ELISA)检测各组血清、以及RA患者关节液中sCD25浓度,并记录RA患者的各项临床表现和实验室指标,分析其与血清sCD25浓度水平的相关性。结果: RA组血清sCD25(质量)浓度为(2 886±1 333) ng/L,OA组血清sCD25浓度为(2 090±718) ng/L,健康对照组血清sCD25浓度为(1 768±753) ng/L;RA患者的血清sCD25水平显著高于疾病对照组和健康对照组(P< 0.001);血清中sCD25水平与红细胞沉降率(r=0.321,P = 0.001)、C-反应蛋白(r=0.446,P<0.001)、DAS28评分(r=0.324, P<0.001)、关节压痛计数(r = 0.203,P =0.024)、D-二聚体(D-dimer)水平(r=0.383,P<0.001)、年龄(r = 0.24,P = 0.007)、总IgG(r = 0.207,P = 0.028)、类风湿因子IgG(r = 0.345,P = 0.034)呈正相关,与病程呈负相关(r = -0.206,P = 0.021);在RA患者中,低疾病活动度组血清ESR、CRP和sCD25阳性率分别为14.3%(2例),14.3%(2例),71.4%(10例);中疾病活动度组血清ESR、CRP和sCD25阳性率分别为94.2%(49例)、82.7%(43例)和86.5%(45例);高疾病活动度组血清ESR、CRP和sCD25阳性率分别为100%(42例)、95.2%(40例)和90.5%(38例);有36例ESR和/或CRP为阴性(约33.3%),在这36例中有17例(约47.2%)血清sCD5水平升高,并且其中14例(约82.4%)DAS28评分高于3.2。结论: 血清sCD25水平与RA活动性密切相关,表明sCD25可能参与了RA的炎症过程,并有望成为RA患者的一种新的炎症指标;血清sCD25的检测在RA处于病情活动期,但ESR和/或CRP为阴性时更有意义。

关键词: 类风湿关节炎,活动性, 可溶性白细胞介素-2受体α链;, 血清sCD25, 血沉, C-反应蛋白

Abstract:

Objective: To evaluate soluble interleukin-2 receptor alpha chain (sIL-2Rα, sCD25) in serum for the determination of rheumatoid arthritis (RA) activity.Methods:Peripheral blood was collected from 108 patients with RA, 39 patients with osteoarthritis (OA) and 50 healthy control subjects, and synovial fluids were from 40 patients with RA. The sera from the patients with RA, the disease control group (osteoarthritis), the healthy control group, and the synovial fluids of the RA patients were detected by enzyme-linked immunosorbent assay (ELISA).The clinical manifestations and laboratory parameters of the patients with RA were recorded and the correlation with the serum sCD25 level was analyzed.Results:The serum sCD25 concentration in RA group was (2 886±1 333) ng/L, the serum sCD25 concentration in OA group was (2 090±718) ng/L, and the serum sCD25 concentration in healthy group was (1 768±753) ng/L. The serum sCD25 level in the patients with RA was significantly higher than that in the disease controls and healthy controls (P<0.001). Sensitivity of serum sCD25 in the diagnosis of RA was 66.1% and specificity was 83.0%;serum sCD25 levels and erythrocyte sedimentation rate (r = 0.321, P = 0.001), C-reactive protein (r=0.446, P<0.001), DAS28 score (r = 0.324, P<0.001), joint tenderness count (r=0.203, P=0.024), D-dimer levels (r=0.383, P<0.001), age (r=0.24, P=0.007), IgG (r=0.207, P=0.028), HRF-IgG (r=0.345, P=0.034) showed a significant positive correlation, and disease duration (r=-0.206, P=0.021) showed a negative correlation with sCD25;In patients with rheumatoid arthritis, the positive rates of serum ESR, CRP, and sCD25 were 14.3% (2 cases), 14.3% (2 cases), and 71.4% (10 cases) in the low disease activity group. The positive rates of serum ESR, CRP and sCD25 in the moderate disease activity group were 94.2% (49 cases), 82.7% (43 cases), and 86.5% (45 cases). The positive rates of serum ESR, CRP, and sCD25 in the high disease activity group were 100% (42 cases), 95.2% (40 cases), and 90.5% (38 cases);36 cases of ESR and/or CRP were negative (about 33.3%) in 108 patients, serum sCD5 levels of 17 cases in these 36 cases (about 47.2%)increased, of which 14 cases (about 82.4%) had a DAS28 score higher than 3.2.Conclusion:The serum sCD25 has a high specificity for diagnosis of RA and a poor sensitivity. The serum level is closely related to the activity of RA, indicating that sCD25 may be involved in the inflammatory process of RA and may become a new inflammatory marker of RA.It is more meaningful for detection of serum sCD25 when RA is active, but ESR and/or CRP is negative.

Key words: Rheumatoid arthritis,activity, Interleukin 2 receptor α chain;, Sera sCD25, Erythrocyte sedimentation rate, C-reactive protein

中图分类号:

R593.22

胥佳佳,王燕,孙贺,贾汝琳,张学武,孟洋,任丽丽,孙晓麟. 可溶性白细胞介素2受体α链的检测与类风湿关节炎疾病活动性评估[J]. 北京大学学报（医学版）, 2018, 50(6): 975-980.

Jia jia XU,Yan WANG,He SUN,Ru lin JIA,Xue wu ZHANG,Yang MENG,Li li REN,Xiao lin SUN. Clinical significance of detection of soluble interleukin 2 receptor alpha chain in the assessment of rheumatoid arthritis disease activity[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 975-980.

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Characteristics	sCD25 in peripheral blood/(ng/L)
Characteristics	r	P
Age/years	0.24	0.007^*
Duration/years	-0.206	0.021*
Tender joints, n	0.203	0.024^*
Swollen joints, n	0.156	0.083
RF/(IU/mL)	0.110	0.248
ESR/(mm/h)	0.321	0.001^*
CRP/(mg/L)	0.446	<0.001^*
ACPA/(IU/mL)	0.043	0.659
RF-IgG/(IU/mL)	0.345	0.034^*
GPI/(mg/L)	0.127	0.375
IgG/(g/L)	0.207	0.028^*
IgA/(g/L)	0.159	0.092
IgM/(g/L)	0.069	0.467
C3/(g/L)	0.083	0.384
C4/(g/L)	0.059	0.537
ASO/(IU/mL)	0.048	0.614
D-dimer/(mg/L)	0.383	<0.001^*
WBC/(×10⁹/L)	0.214	0.017^*
Neu/%	0.262	0.003^*
DAS28	0.324	<0.001^*

Items	LDA(n=14)	MDA(n=52)	HDA(n=42)
DAS28	3.11±0.05	4.46±0.51	5.67±0.32
ESR/(mm/h)^*	12.50±5.58	32.62±23.18	62.19±28.45
CRP/(mg/L)^*	17.00±2.05	19.65±25.16	50.26±38.16
sCD25/(ng/L)^*	2 592±1 380	2 904±1 821	3 351±1 974