Wu Tongxin, Gu Liyang, Shi Bisheng, Wu Yiwei, Yang Jinming, He Zhengting, He Xi, Zhu Xinyun, Lu Liangjing, Chen Xiaoxiang, Guo Ruru
Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shan Dong Middle Road, Shanghai, 200001, China.
Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Arthritis Res Ther. 2025 Jul 10;27(1):144. doi: 10.1186/s13075-025-03611-x.
Macrophage activation syndrome (MAS) represents a severe and potentially life-threatening complication of adult-onset Still's disease (AOSD), necessitating the identification of sensitive and specific biomarkers for early diagnosis. Our study found significantly elevated CD64 mRNA expression in neutrophils of AOSD patients compared to healthy controls (p = 0.029). The neutrophil CD64 index (nCD64 index) positively correlated with key clinical manifestations, including splenomegaly, sore throat, pulmonary infiltrates, and pericarditis. Effective treatments led to a rapid and significant decrease in the nCD64 index (p < 0.001). Logistic regression showed that an elevated nCD64 index is a risk factor for MAS (OR = 1.073, p = 0.003). ROC curve analysis indicated that the nCD64 index reliably distinguished AOSD patients with MAS (AUC = 0.877; cutoff = 32.09; p < 0.001) and combined utilization of nCD64 index, ferritin, and sIL-2R demonstrated a strong predictive value. Correlations with hospitalization length (r = 0.382, p < 0.001) and maximum glucocorticoid dose (r = 0.326, p = 0.003) were also observed. Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MAS in patients with an nCD64 index > 32.09 (p < 0.001). These findings suggest the nCD64 index is a promising biomarker for early identifying AOSD patients at risk of MAS, aiding in timely diagnosis and management.
巨噬细胞活化综合征（MAS）是成人斯蒂尔病（AOSD）的一种严重且可能危及生命的并发症，因此需要识别敏感且特异的生物标志物用于早期诊断。我们的研究发现，与健康对照相比，AOSD患者中性粒细胞中CD64 mRNA表达显著升高（p = 0.029）。中性粒细胞CD64指数（nCD64指数）与关键临床表现呈正相关，包括脾肿大、咽痛、肺部浸润和心包炎。有效的治疗导致nCD64指数迅速且显著下降（p < 0.001）。逻辑回归显示，nCD64指数升高是MAS的危险因素（OR = 1.073，p = 0.003）。ROC曲线分析表明，nCD64指数能够可靠地区分患有MAS的AOSD患者（AUC = 0.877；临界值 = 32.09；p < 0.001），并且联合使用nCD64指数、铁蛋白和sIL-2R具有很强的预测价值。还观察到与住院时间（r = 0.382，p < 0.001）和最大糖皮质激素剂量（r = 0.326，p = 0.003）的相关性。Kaplan-Meier分析显示，nCD64指数> 32.09的患者中MAS的累积发病率显著更高（p < 0.001）。这些发现表明，nCD64指数是早期识别有MAS风险的AOSD患者的有前景的生物标志物，有助于及时诊断和管理。
