자동화 검사법으로 측정한 혈청 히알루론산의 평가: 류마티스관절염 진단을 위한 = Evaluation of Automated Assays for Measuring Serum Hyaluronic Acid: For the Diagnosis of Rheumatoid Arthritis

국문 초록 (Abstract)

배경: 히알루론산은 결합조직에 존재하면서 윤활제 기능을 하며, 관절에 염증이 발생하면 윤활액과 혈청 모두에서 농도가 증가하는 것으로 알려져 있다. 본 연구에서는 자동화 분석법으로 혈청 히알루론산 농도를 측정하고 이의 참고구간 설정 및 류마티스관절염의 진단을 위한 표지자로서의 유용성을 평가하였다.
방법: 건강인 121명과 환자 253명의 혈청 검체에서 LPIAACE 시약 (Mitsubishi, Japan)과 LT Auto Wako (Wako, Japan) 시약을 사용한 두 종류의 자동화 정량검사를 이용하여 히알루론산 농도를 측정하였다. 혈청 히알루론산 농도와 류마티스관절염의 진단 간의 관련성을 ROC 곡선과 다변량로지스틱회귀분석을 사용하여 평가하였다.
결과: 혈청 히알루론산 농도의 95 백분위수 상위 참고구간은 LPIAACE 시약에서는 57.28 ng/mL (90% CI, 46.30-68.20), LT Auto Wako 시약은 72.64 ng/mL (90% CI, 57.30-85.70)였다. 류마티스관절염군과 기타 전체 대상군을 감별하기 위한 혈청 히알루론산의 AUC는 LPIAACE 시약의 경우 0.68, LT Auto Wako 시약의 경우 0.70이었다. 류마티스관절염을 예측하는 데 있어 혈청 히알루론산 농도의 OR은 LPIAACE 시약의 경우 1.02 (95% CI, 1.02-1.04), LT Auto Wako 시약은 1.03 (95% CI, 1.02-1.05)이었다.
결론: 본 연구에서는 한국인의 혈청 히알루론산 농도의 성인 참고구간을 제시하였다. 혈청 히알루론산은 류마티스관절염과 건강인 및 기타 관절염의 감별을 위한 보완적인 표지자로서 도움이 될 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Background: Hyaluronic acid (HA) is present in the connective tissues wherein it functions as a lubricant. HA is known to be increased in both synovial fluid and serum when inflammation occurs in the joint. We measured serum HA concentrations by automated assays and determined its reference interval and its usefulness as a diagnostic marker in patients with rheumatoid arthritis (RA).
Methods: Serum specimens collected from 121 healthy individuals and 253 patients with various arthritis were used for measuring HA with two automated assays, namely, LPIAACE (Mitsubishi, Japan) and LT Auto Wako (Wako, Japan). The association between serum HA concentration and the diagnosis of RA was estimated by receiver operator characteristic (ROC) analysis and multivariate logistic regression.
Results: The 95th percentile upper reference limit of serum HA was 57.28 ng/mL (90% confidence interval [CI], 46.30-68.20 ng/mL) for LPIAACE and 72.64 ng/mL (90% CI, 57.30-85.70 ng/mL) for LT Auto Wako. Area under the ROC curve values of serum HA for discriminating the RA group from the non-RA group were 0.68 for LPIAACE and 0.70 for LT Auto Wako. The odds ratio for serum HA in predicting RA was 1.02 (95% CI, 1.02-1.04) for LPIAACE and 1.03 (95% CI, 1.02-1.05) for LT Auto Wako.
Conclusions: This study provides a reference interval for serum HA concentrations in Koreans. This result suggests that the serum HA concentrations could be helpful as a complementary marker for discriminating RA from other types of arthritis, as well as distinguishing patients with RA from healthy controls.

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