Zhang Hui, Yang Guizhao, Jiang Rongqiong, Feng Dan, Li Yuqin, Chen Yong, Yuan Guohua
Institute of Rheumatism and Immunology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China.
Department of Rheumatism and Immunology, the People's Hospital of Jianyang City, Jianyang, People's Republic of China.
Int J Gen Med. 2023 Jan 24;16:273-280. doi: 10.2147/IJGM.S393273. eCollection 2023.
Rheumatoid arthritis (RA) is a systemic inflammatory disorder with unknown etiology. Oxidative stress and immune imbalance play a critical role in the pathogenesis of rheumatoid arthritis. Bilirubin has recently been recognized as a potent antioxidant as well as an immunomodulatory agent of physiological importance. The aim of this study was to explore whether increased bilirubin concentrations are correlated with good clinical prognosis of rheumatoid arthritis.
In this cross-sectional study, we included 197 healthy individuals and 197 RA patients in the Affiliated Hospital of North Sichuan Medical College from October 2020 to February 2022. The latter were classified into three classes of disease activity according to DAS28-ESR: remission and low (DAS28-ESR<3.2), moderate (3.2≤DAS28-ESR≤5.1), and high (DAS28ESR>5.1). Based on the clinical and laboratory data, we evaluated the association of bilirubin levels with disease activity in RA using multivariable ordered logistic regression.
The levels of total bilirubin and total bilirubin/albumin ratio were significantly lower (P < 0.001; P < 0.001) in RA patients compared with healthy controls. In RA patients, Spearman's rank correlation analysis revealed that bilirubin and total bilirubin/albumin ratio were negatively correlated with disease activity and inflammatory marker (C-reactive protein, erythrocyte sedimentation rate, Interleukin-6). In multivariable ordered logistic regression, higher total bilirubin (OR=0.77, 95% CI: 0.67-0.89, <0.001) independently predicted lower disease activity.
Bilirubin levels remain associated with a reduction of disease activity, suggesting that bilirubin may be a protective factor for RA aggravation.
类风湿关节炎（RA）是一种病因不明的全身性炎症性疾病。氧化应激和免疫失衡在类风湿关节炎的发病机制中起关键作用。胆红素最近被认为是一种有效的抗氧化剂以及具有生理重要性的免疫调节剂。本研究的目的是探讨胆红素浓度升高是否与类风湿关节炎的良好临床预后相关。
在这项横断面研究中，我们纳入了2020年10月至2022年2月在川北医学院附属医院的197名健康个体和197名RA患者。后者根据DAS28-ESR分为三类疾病活动度：缓解和低度（DAS28-ESR<3.2）、中度（3.2≤DAS28-ESR≤5.1）和高度（DAS28-ESR>5.1）。基于临床和实验室数据，我们使用多变量有序逻辑回归评估了胆红素水平与RA疾病活动度的关联。
与健康对照相比，RA患者的总胆红素水平和总胆红素/白蛋白比值显著更低（P<0.001；P<0.001）。在RA患者中，Spearman等级相关分析显示胆红素和总胆红素/白蛋白比值与疾病活动度和炎症标志物（C反应蛋白、红细胞沉降率、白细胞介素-6）呈负相关。在多变量有序逻辑回归中，较高的总胆红素（OR=0.77，95%CI：0.67-0.89，<0.001）独立预测较低的疾病活动度。
胆红素水平仍然与疾病活动度的降低相关，表明胆红素可能是RA病情加重的一个保护因素。
