| Objective: To demonstrate the clinical value of combined detection of procalcitonin(PCT),calcitonin(CT),rheumatoid factor(RF),anti-cyclic citrullinated peptide(anti-CCP)and anti-RA33antibody(anti-RA33)in the diagnosis of early rheumatoid arthritis(RA).Method: A total of 82 patients with RA treated in our hospital from October 2018 to November 2019 were selected as RA group,all of which met the 2010 RA Classification Criteria by the American College of Rheumatology(ACR).According to the disease duration,RA group was divided into early RA group(disease duration ? 1 year)and established RA group(disease duration > 1 year).98 non-RA patients admitted in the same period were non-RA group,including systemic lupus erythematosus(SLE)group(n = 37),osteoarthritis(OA)group(n = 30),gouty arthritis(GA)group(n = 31)and healthy control group(n = 80).PCT and CT were measured using electrochemiluminescence immunoassay(ECLIA).The levels of PCT,CT,anti-CCP antibody(ELISA method),anti-RA33 antibody(ELISA method)and RF(rate nephelometry)were compared among early RA group,established RA group,SLE group,OA group,GA group and healthy control group.To evaluate the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and receiver-operator characteristic(ROC)curves of RF,anti-CCP antibody,anti-RA33 antibody and combined detection of PCT and CT in the diagnosis of early RA,and to analyze the clinical diagnostic significance of early RA.To explore the correlation of PCT and CT with age,disease duration,sharp score of imaging progression and clinical laboratory related indexes of C-reactive protein(CRP),Erythrocyte sedimentation rate(ESR),RF,anti-CCP antibody,and anti-RA33 antibody.Results:1.Median serum PCT concentration in early RA group,OA group and healthy control group was 0.065 ng/ml,0.025ng/ml and 0.024ng/ml,respectively.Compared with the three groups,the level of PCT in early RA group increased significantly(P<0.05).Median serum CT concentration in early RA group,SLE group,GA group and healthycontrol group was 0.880pg/ml,2.480 pg/ml,2.550 pg/ml and 3.159pg/ml,respectively.The CT level in early RA group was significantly lower than that in early RA group(P<0.05).2.Compared with all the controls,the area under the ROC curve(AUC)of RF and anti-RA33 antibody in the early RA group was 0.60,0.65 respectively,the additions of PCT and CT further improved the diagnostic ability of early RA with the AUC of 0.80,0.79,respectively(P<0.05).The ROC of RF + anti-CCP antibody,RF +anti-RA33 antibody was 0.72,0.66 respectively,the combined detection of PCT and CT further improved the diagnostic ability of early RA with the AUC of 0.83,0.81,respectively(P<0.05).Compared with the sensitivity and specificity of RF and anti-RA33 antibody,the sensitivity increased significantly,but the specificity decreased slightly with the additions of PCT and CT(P<0.05).Compared with the sensitivity and specificity of RF + anti-CCP antibody,RF + anti-RA33 antibody,the sensitivity of combined detection of PCT and CT increased significantly(P<0.05).3.Compared with the non-RA group,the AUC detected by RF combined with PCT and CT(0.76)was significantly higher than the AUC detected by RF alone(0.55)in the early RA group(P<0.05).The AUC of RF + anti-RA33 antibody increased from 0.61 to 0.76 with the additions of PCT and CT(P<0.05).Compared with the sensitivityand specificity of RF and anti-CCP antibody,combined with PCT and CT,the sensitivity increased significantly,but the specificity decreased slightly(P<0.05).Compared with the sensitivity and specificity of RF+ anti-RA33 antibody,when combined with PCT and CT,the sensitivity increased significantly and the specificity decreased slightly(P<0.05).4.Compared with the healthy control group,the AUC of RF,anti-CCP antibody and anti-RA33 antibody in the early RA group was0.66,0.73,0.64,respectively,the additions of PCT and CT further improved the diagnostic ability of early RA with the AUC of 0.97,0.98,0.97,respectively(P<0.05).The ROC of RF + anti-CCP antibody,RF + anti-RA33 antibody,anti-CCP antibody + anti-RA33 antibody was 0.74,0.73,0.75,respectively,the combined detection of PCT and CT further improved the diagnostic ability of early RA with the AUC of 0.98,0.97,0.98,respectively(P<0.05).Compared with the sensitivity and specificity of RF,anti-CCP antibody and anti-RA33 antibody,the sensitivity and specificity of combined PCT and CT detection were significantly increased(P<0.05).Compared with the sensitivity and specificity of RF+ anti-CCP antibody,RF+anti-RA33 antibody,anti-CCP antibody + anti-RA33 antibody,when combined with PCT and CT,the sensitivity and specificity were significantly increased(P<0.05).5.Correlation analysis showed that PCT and CT were not significantly correlated with age,disease duration,sharp score of imaging progression and clinical laboratory related indexes of CRP,ESR,RF,anti-CCP antibody and anti-RA33 antibody in early RA.Conclusions:1.PCT and CT combined with RA related biomarkers have high diagnostic value in early RA.2.In early RA,the level of PCT was higher and the level of CT was lower than that of healthy control group.3.The detection of PCT and CT combined with RA-related biomarkers can significantly improve the sensitivity of early RA diagnosis.4.Among the different combinations of PCT,CT and RF,anti-CCP antibody and anti-RA33 antibody,the combined detection of PCT + CT + anti-CCP antibody + anti-RA33 antibody has high specificity and sensitivity of early RA diagnosis,and the diagnostic performance is the best. |
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