血沉及C反应蛋白判定强直性脊柱炎病情活动的价值

目的探讨血沉和C反应蛋白(CRP)判定强直性脊柱炎(AS)病情活动的价值。方法采用Cowling法和Bath强直性脊柱炎病情活动指标(BASDAI)评价126例AS患者的病情活动性,分为静止、可疑活动、活动3个水平;患者分为脊柱组和外周关节组。病情静止和活动者纳入受试者工作曲线,以最高敏感性和特异性决定截断点,计算血沉、CRP与病情活动间Spearman相关系数。结果脊柱组血沉和CRP中位数为25·3mm/1h和11·1mg/L,外周关节组为30·0mm/1h和15·0mg/L。两组间血沉和CRP呈正相关(rs=0·325和0·318,P<0·05)。血沉、CRP和两种病情活动评价指标无相关性(0·027~0·282),两者对Cowling法和BASDAI评价病情活动敏感性为39·4%~81·3%,特异性为40·0%~86·7%。结论血沉、CRP与Cowling法和BASDAI评价AS病情活动性之间无联系,其对判定AS病情活动性价值不大。

The value of erythrocyte sedimentation rate and C-reactive protein in evaluating disease activity in ankylosing spondylitis

OBJECTIVE: To determine whether erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) is more appropriate in measuring the disease activity in ankylosing spondylitis (AS). METHODS: We studied 126 consecutive patients with AS. The external criteria for disease activity were Cowling clinical assessment of disease activity and the Bath AS disease activity index (BASDAI). In each measure we defined 3 levels of disease activity i.e. no activity, ambiguous activity and definite activity. The patients with AS were divided into 2 groups: those with spinal involvement only and those with peripheral arthritis as well. For each criterion of disease activity, the patients without activity and with definite activity were included in receiver operating characteristic curve, which was used to determine cutoff values with the highest sensitivity and specificity. We also calculated Spearman correlation. RESULTS: The median ESR and CRP were 25.3 mm/1 h and 11.1 mg/L in the spinal group and 30.0 mm/1 h and 15.0 mg/L in the peripheral group. In both groups the Spearman correlation coefficients between ESR and CRP were around 0.30. There was no correlation between ESR, CRP, and the 2 disease activity variables (0.027-0.282). Sensitivity for both ESR and CRP was between 39.4 %and 81.3% for Cowling assessment of disease activity and the BASDAI, while specificity was between 40.0% and 86.7% for all disease activity measures. CONCLUSION: It is concluded that neither ESR nor CRP is superior for assessing disease activity in ankylosing spondylitis.