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目的研究血清淀粉样蛋白A(serum amyloid A protein,SAA)在幼年特发性关节炎(juvenile idiopathic arthritis,JIA)疾病活动度评估中的临床应用价值。方法选取JIA患儿102例收集其血常规、SAA、血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)及骨密度结果,采用幼年关节炎疾病活动评分(juvenile arthritis disease activity score with 27 joints,JADAS-27)对疾病活动程度进行评估并比较其相关性。采用便利抽样法选取年龄性别成组匹配的健康体检儿童51例作为对照组。结果 JIA患儿血清SAA水平显著高于健康对照组(96.1 mg/L vs 16.8 mg/L,P<0.05)。血清SAA水平在全身型JIA患儿中较关节型患儿升高明显。活动期JIA患儿SAA水平较稳定期显著升高。SAA与CRP(r=0.819)、ESR(r=0.712)均呈显著正相关(P<0.01)。SAA的ROC曲线下面积(area under the ROC curve,AUC)达0.795,仅次于血沉(AUC=0.860),较CRP及其他指标更高。当SAA或血小板任意一项异常,且二者之和大于354时,判断疾病活动敏感性达0.71,特异性达0.84。JADAS-27评分与SAA、CRP均呈低度相关(r值0.33-0.48,P<0.01),与血沉呈中度相关(r=0.64)。疾病高度活动状态下,SAA显著升高。结论 SAA,尤其是SAA联合血小板计数增高,有望作为新的JIA疾病活动度评估指标,值得在临床进一步推广。
Objective To investigate the clinical value of serum amyloid A protein (SAA) in the assessment of juvenile idiopathic arthritis (JIA) disease activity. Methods Blood samples, SAA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and bone mineral density (BMD) were collected from 102 children with JIA. Juvenile arthritis disease score activity score with 27 joints, JADAS-27) to assess disease activity and compare their relevance. The convenience sampling method was used to select 51 healthy children of matched age and sex group as the control group. Results Serum SAA levels in JIA children were significantly higher than those in healthy controls (96.1 mg / L vs 16.8 mg / L, P <0.05). Serum SAA levels were significantly higher in patients with systemic JIA than in infants with joint disease. Activity of SAA in children with SAA was significantly higher than the steady-state. There was a significant positive correlation between SAA and CRP (r = 0.819) and ESR (r = 0.712) (P <0.01). The area under the ROC curve (AUC) of SAA was 0.795, second only to ESR (AUC = 0.860), which was higher than CRP and other parameters. When any one of SAA or platelet abnormalities, and the sum of the two is greater than 354, the disease activity sensitivity of 0.71, specificity of 0.84. There was a low correlation between JADAS-27 score and SAA and CRP (r = 0.33-0.48, P <0.01), and was correlated with ESR (r = 0.64). SAA was significantly elevated in highly active disease. Conclusion SAA, especially SAA combined platelet count increased, is expected as a new JIA disease activity evaluation index, it is worth further promotion in the clinical.