Chen Shuyang, Huang Xuechan, Huang Yukai, Zhao Wenkai, Zheng Shaoling, Huang Qidang, Li Tianwang
The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China; Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, Guangdong Province, China.
Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou 510317, Guangdong Province, China.
Clin Chim Acta. 2020 Nov;510:483-487. doi: 10.1016/j.cca.2020.08.012. Epub 2020 Aug 12.
Gout is an inflammatory disease characterized by the deposition of monosodium urate (MSU) in synovial fluid and other tissues. Many studies have shown that the activation of coagulation system had been proposed correlated with systemic inflammation. The concentrations of plasma fibrinogen and D-dimer are increased in abnormal coagulation, emerging as available indicators to predict systemic inflammation. The aim of this study is to reveal the predictive value of plasma fibrinogen, D-dimer in the disease activity of gout patients.
This retrospective study included 334 gout patients and 101 age- and gender- matched healthy controls. The gout patients were divided into two groups according to the gout activity score (GAS = 0.09 × last 12 month attacks + 1.01 × sUA + 0.34 × VAS patient + 0.53 × ln(1 + tophi number). The remission group included 46 patients with GAS of lower than 2.5 and the active group included 288 patients with GAS of 2.5 or higher. Clinical and laboratory data were recorded. The correlations between plasma fibrinogen, D-dimer and GAS were analyzed by Spearman's correlation analysis and Partial correlation analysis. Receiver operating characteristic (ROC) was used to evaluate the diagnostic value for the active group compared with remission group. The predictive value of fibrinogen, D-dimer to the disease activity of gout patients was tested by Binary logistic regression analysis.
Plasma fibrinogen and D-dimer in gout patients (3.66 (2.88, 5.20), 0.29 (0.22, 0.80)) were increased as compared with the control group (2.88 (2.51, 3.24), 0.22 (0.22, 0.32), both P < 0.001). Fibrinogen and D-dimer in active group (3.91 (3.00, 5.53), 0.34 (0.22, 0.86)) were higher than those in remission group (2.88 (2.34, 3.22), 0.22 (0.22, 0.26), both P < 0.001)). Plasma fibrinogen, D-dimer, ESR and CRP were positively correlated with GAS (r = 0.606, r = 0.419, r = 0.570, r = 0.440, all P < 0.001). ROC curve showed fibrinogen yielded a highest AUC than D-dimer, ESR, CRP. In addition, the optimal cutoff value of fibrinogen for active group was 3.60, with a specificity of 89.1% and sensitivity of 58.3%. Binary logistic regression analysis showed fibrinogen (odds ratio = 2.71, 95% confidence interval: 1.28-5.74, p = 0.011) was a predictor for gout disease activity.
Fibrinogen was increased in active gout group. Fibrinogen can serve as a reliable inflammatory marker for monitoring inflammatory response and disease activity in gout patients.
痛风是一种炎症性疾病，其特征是滑膜液和其他组织中存在尿酸钠（MSU）沉积。许多研究表明，凝血系统的激活与全身炎症相关。血浆纤维蛋白原和D-二聚体浓度在凝血异常时升高，成为预测全身炎症的可用指标。本研究旨在揭示血浆纤维蛋白原、D-二聚体对痛风患者疾病活动的预测价值。
这项回顾性研究纳入了334例痛风患者和101例年龄及性别匹配的健康对照者。痛风患者根据痛风活动评分（GAS = 0.09×过去12个月发作次数 + 1.01×血清尿酸 + 0.34×患者视觉模拟评分 + 0.53×ln(1 + 痛风石数量)）分为两组。缓解组包括46例GAS低于2.5的患者，活动组包括288例GAS为2.5或更高的患者。记录临床和实验室数据。通过Spearman相关分析和偏相关分析分析血浆纤维蛋白原、D-二聚体与GAS之间的相关性。采用受试者工作特征（ROC）曲线评估活动组与缓解组相比的诊断价值。通过二元逻辑回归分析检验纤维蛋白原、D-二聚体对痛风患者疾病活动的预测价值。
与对照组（2.88(2.51, 3.24)，0.22(0.22, 0.32)，P均<0.001）相比，痛风患者的血浆纤维蛋白原和D-二聚体（3.66(2.88, 5.20)，0.29(0.22, 0.80)）升高。活动组的纤维蛋白原和D-二聚体（3.91(3.00, 5.53)，0.34(0.22, 0.86)）高于缓解组（2.88(2.34, 3.22)，0.22(0.22, 0.26)，P均<0.001）。血浆纤维蛋白原、D-二聚体、红细胞沉降率（ESR）和C反应蛋白（CRP）与GAS呈正相关（r = 0.606，r = 0.419，r = 0.570，r = 0.440，P均<0.001）。ROC曲线显示纤维蛋白原的曲线下面积（AUC）高于D-二聚体、ESR、CRP。此外，活动组纤维蛋白原的最佳截断值为3.60，特异性为89.1%，敏感性为58.3%。二元逻辑回归分析显示纤维蛋白原（比值比 = 2.71，95%置信区间：1.28 - 5.74，P = 0.011）是痛风疾病活动的预测指标。
活动期痛风组纤维蛋白原升高。纤维蛋白原可作为监测痛风患者炎症反应和疾病活动的可靠炎症标志物。
