| Objective:To investigate the expression level of growth transforming factor 15(GDF15)in serum of patients with rheumatoid arthritis(RA),disease activity and clinical significance of subclinical atherosclerosis.Method:A total of 52 patients with rheumatoid arthritis newly diagnosed in the Department of Rheumatology and Immunology of Jiangxi Provincial People’s Hospital from September 2018 to May 2020 were selected as the case group,and 40 healthy subjects were selected as the control group.Serum GDF15 levels of newly diagnosed RA patients and healthy control group were detected by enzyme-linked immunosorbentassay(ELISA).Application of automatic biochemical analyzer test two groups of serum total cholesterol(TC),three acyl glycerin(TG),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and using PhillipHDI5000 color doppler ultrasonic diagnostic instrument measurement of carotid intima-media thickness(IMT),calculation of RA patients with 28 joint disease activity score(DAS28-the ESR score),divided into RA disease activity score>2.6 group,with scores of 2.6 or less divided into RA disease activity group,The levels of GDF 15 in RA disease activity group,RA non-disease activity group and healthy control group were compared,and the correlation between GDF 15 levels and age,sex,disease course,body mass index,blood lipid levels,carotid IMT,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),RF,CCP,IL-6 levels and DAS28-ESR score were analyzed within the groups.All data were analyzed by SPSS 23.0 statistical software,and P<0.05 was considered statistically significant.Result:①The serum GDF15 level of RA group[(1384.54±304.40)pg/ml]was significantly higher than that of healthy control group[(783.10±115.43)pg/ml],and the difference was statistically significant(t=11.826,P=0.000).② The serum GDF15 level of RA disease activity group[(1571.14±228.62)pg/ml]was significantly higher than that of RA non-disease activity group[(1106.62.14±151.08)pg/ml],and the difference was statistically significant(t=-8.168,P=0.000).③The levels of blood lipid including TC,TG and carotid IMT in RA group were higher than those in healthy control group,and the levels of HDL-C were lower than those in healthy control group,which were[(5.42±0.53)vs(4.18±0.42)mmol/L,t=8.852;(1.86±0.35)vs(1.24±0.35)mmol/L,t=5.745;(1.19±0.26)vs(0.83±0.20)mm,t=5.311;(0.93±0.18)vs(1.21±0.10)mmol/L,t=-9.921;P 均<0.05],the difference was statistically significant;There was no significant correlation between LDL-C in RA group and healthy control group(t=2.678,P>0.05).④The TC and TG of RA activity group were higher than that of healthy control group,and the HDL-C was lower than that of healthy control group,which were[5.47±0.48)vs(4.98±0.42)mmol/L,t=-9.995;(1.81±0.21)vs(1.64±0.35)mmol/L,t=7.961;(1.32±0.29)vs(1.03±0.20)mmol/L,t=-5.622;(0.88±0.15)vs(1.07±0.10)mmol/L,t=-1.856;P 均<0.05]the difference was statistically significant.There was no significant difference in LDL-C between the two groups(t=1.305,P>0.05).(5)Serum GDF15 level was positively correlated with DAS28(r=0.860,P=0.000),ESR(r=0.836,P=0.000),CRP(r=0.647,P=0.000),and had no correlation with age,course of disease,RF,CCP,IL-6(all P=>0.05).(6)The serum GDF15 level was positively correlated with TC(r=0.327,P=0.018)TG(r=0.653,P=0.000)and carotid IMT(r=0.475,P=0.000).The serum GDF15 level was negatively correlated with HDL-C(r=-0.682,P=0.000),but not with LDL-L(P>0.05).⑦ ROC curve analysis showed that the area under ROC curve for the diagnosis of carotid intima thickening in RA by serum GDF15 level was 0.777(95%CI:0.676～0.879,P=0.000),the optimal cut-off value was 1204.88pg/ml,the sensitivity was 0.733,the specificity was 0.894.Conclusion:1.Compared with the healthy control group,serum GDF 15 level was significantly increased in the RA group,but correlation analysis showed that serum GDF 15 level was not correlated with RF,CCP and IL-6,suggesting that it may be another indicator for early diagnosis of RA independent of the existing gold standard for RA.2.The level of serum GDF15 in RA disease activity group was significantly higher than that in RA non-disease activity group.Meanwhile,it was found that the level of GDF15 in RA disease activity group was correlated with the activity indexes(ESR,CRP,DAS28-ESR),suggesting that GDF15 may be correlated with the disease activity of RA,and it has a certain evaluation value for the activity of RA.3.There were dyslipidemia and carotid intima thickening in RA group,which were correlated with GDF15 level,suggesting that GDF15 may be an effective monitoring index for early detection of RA complicated with atherosclerosis and a target for intervention therapy. |
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