The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
Division of Rheumatology, Department of Medicine, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
Cytokine. 2020 Dec;136:155251. doi: 10.1016/j.cyto.2020.155251. Epub 2020 Aug 19.
Patients with rheumatoid arthritis (RA) are more susceptible to infections, which elevate the levels of relative cytokines. However, the ability of the cytokines levels to predicate bacterial infections in RA patients remains unclear. Here, we assessed the ability of the combination of serum cytokine levels and blood parameters to diagnose bacterial infections in RA patients. We measured the levels of a panel of serum cytokine and blood parameters in 168 RA patients and 81 healthy individuals. RA patients were divided into the bacterial infection (INFE) group (n = 76) and RA flare without INFE group (n = 92). Bacterial infection was confirmed by microbial culture, imaging, antibiotic response, and typical clinical symptoms. The discriminative ability of the combination of the cytokine levels and inflammatory parameters was assessed using the receiver-operating characteristic (ROC) curves analysis and a novel bioscore system. The levels of interleukin (IL)-6 (p = 0.006), IL-10 (p = 0.019), interferon (IFN)-γ (p = 0.033), CRP (p < 0.001), and ESR (p < 0.001) were higher in patients of the INFE group than in patients with RA flare, and the absolute numbers of CD19 B cells (p < 0.001) and CD4 T cells (p = 0.009) were lower. For discriminating bacterial infection, the combination of IL-6, IL-10, IFN-γ, ESR, CRP, CD19 B cells, and CD4 T cells, provided an area under the curve (AUC) of 0.827 [(95% confidence interval (CI): 0.760-0.881)], which was profoundly larger than that of IL-6, IL-10, IFN-γ, ESR, CRP, CD19 B cells, or CD4 T cells alone. In addition, we also developed a bioscore system based on the combination of these seven biomarkers. Seventeen (100%) patients with a bioscore of 0 were non-infected, while seven (100%) patients with a score of 7 had bacterial infections. The bioscore based on the combination of ESR, CRP, IL-6, IL-10, IFN-γ, CD19 B cells and CD4 T cells may be a promising and robust tool to diagnose bacterial infections in RA patients.
类风湿关节炎（RA）患者更容易感染，这会导致相关细胞因子水平升高。然而，细胞因子水平预测 RA 患者细菌感染的能力尚不清楚。在这里，我们评估了血清细胞因子和血液参数组合诊断 RA 患者细菌感染的能力。我们测量了 168 例 RA 患者和 81 名健康个体的一组血清细胞因子和血液参数水平。RA 患者分为细菌感染（INFE）组（n=76）和 RA 发作无 INFE 组（n=92）。细菌感染通过微生物培养、影像学、抗生素反应和典型临床症状确认。使用受试者工作特征（ROC）曲线分析和新型生物评分系统评估细胞因子水平和炎症参数组合的鉴别能力。INFE 组患者的白细胞介素（IL）-6（p=0.006）、IL-10（p=0.019）、干扰素（IFN）-γ（p=0.033）、C 反应蛋白（CRP）（p<0.001）和红细胞沉降率（ESR）（p<0.001）水平均高于 RA 发作患者，而 CD19 B 细胞（p<0.001）和 CD4 T 细胞（p=0.009）的绝对数量较低。对于鉴别细菌感染，IL-6、IL-10、IFN-γ、ESR、CRP、CD19 B 细胞和 CD4 T 细胞的组合提供了 0.827 的曲线下面积（AUC）[（95%置信区间（CI）：0.760-0.881）]，显著大于 IL-6、IL-10、IFN-γ、ESR、CRP、CD19 B 细胞或 CD4 T 细胞单独的 AUC。此外，我们还基于这七种生物标志物的组合开发了一种生物评分系统。生物评分 0 的 17 名（100%）患者均未感染，而评分 7 的 7 名（100%）患者均有细菌感染。基于 ESR、CRP、IL-6、IL-10、IFN-γ、CD19 B 细胞和 CD4 T 细胞组合的生物评分可能是诊断 RA 患者细菌感染的一种有前途和强大的工具。
