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Article(id=1324071016913317964, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202507178, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1752163200000, receivedDateStr=2025-07-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793612730481, onlineDateStr=2026-11-02, pubDate=1766592000000, pubDateStr=2025-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793612730481, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793612730481, creator=13701087609, updateTime=1793612730481, updator=13701087609, issue=Issue{id=1324070892967428793, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='1766592000000', pubDateStr='2025-12-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793612700931, creator='13701087609', updateTime=1793612772549, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324071193430602023, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324071193430602024, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4584, endPage=4590, ext={EN=ArticleExt(id=1324071017114644557, articleId=1324071016913317964, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Correlation of C-reactive protein-albumin-lymphocyte index with rheumatoid arthritis: a cross-sectional NHANES-based study, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the value of the C-reactive protein-albumin-lymphocyte (CALLY) index as a predictor of rheumatoid arthritis (RA) risk in the general population.

Methods

Data from 9 791 participants in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included. The CALLY index was calculated, and multiple models were used to investigate and evaluate the association between CALLY and RA.

Results

Compared to the lowest quartile (Q1) of the CALLY index, the odds ratio (OR) for RA were 0.71 (95% CI: 0.57-0.89) for Q2, 0.63 (95% CI: 0.49-0.80) for Q3, and 0.49 (95% CI: 0.37-0.65) for Q4. A significant non-linear relationship existed between the CALLY index and RA (P<0.001).

Conclusion

The CALLY index demonstrates a significant negative correlation with the risk of rheumatoid arthritis.

, authors=Yi-hang DING1, Lu-ying WANG1, Si-yi LU1, Xiu-juan HOU2, authorsList=Yi-hang DING, Lu-ying WANG, Si-yi LU, Xiu-juan HOU, authorCompany=null, correspAuthors=Xiu-juan HOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324071018159026263, articleId=1324071016913317964, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=C反应蛋白-白蛋白-淋巴细胞指数与类风湿关节炎的相关性研究：基于NHANES的横断面研究, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

分析C反应蛋白-白蛋白-淋巴细胞（The C-reactive protein-albumin-lymphocyte，CALLY）指数在一般人群中作为类风湿关节炎（Rheumatoid arthritis，RA）患病风险预测因子的价值。

方法

纳入了2007年至2018年美国全国健康和营养检查调查（NHANES）9 791名参与者的数据。计算CALLY 指数，采用多种模型来研究和评估CALLY 与RA之间的关联。

结果

与CALLY最低四分位数（Q1）相比，Q2组患类风湿关节炎的OR=0.71（95% CI：0.57～0.89），Q3组OR=0.63（95% CI：0.49～0.80），Q4组OR=0.49（95% CI：0.37～0.65）。CALLY 指数与RA之间存在显著的非线性关系（P <0.001）。

结论

CALLY指数与类风湿关节炎患病风险之间存在着显著的负相关性。

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丁一航（2001—），女，硕士在读，研究方向：风湿免疫病的中医药防治

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侯秀娟，E-mail：
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注：A为未调整任何协变量；B为调整了年龄、性别、种族、婚姻状况、BMI、教育程度；C为调整了年龄、性别、种族、婚姻状况、BMI、教育程度、吸烟、饮酒、高血压、糖尿病。

, figureFileSmall=Gb+h3B5cnQIsAFR2sqN4xw==, figureFileBig=Eyfu0Rgw/jUZWek59UVc0A==, tableContent=null), ArticleFig(id=1324071025591332987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=EN, label=Fig.2, caption=The relationship between the CALLY index and RA, stratified by age, sex, ethnicity, marital, education, smoke, alcohol, hypertension, and diabetes, figureFileSmall=Y5OsP12NnMuVWsnsEMd4TA==, figureFileBig=GAgwJKGMXqN+n7f3XaaOOQ==, tableContent=null), ArticleFig(id=1324071025704579196, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=CN, label=图2, caption=CALLY指数与RA的关系，按年龄、性别、种族、婚姻状况、教育程度、吸烟、饮酒、高血压和糖尿病分层分析

注：A为按年龄进行分层分析；B为按性别进行分层分析；C为按婚姻状况进行分层分析；D为按种族进行分层分析；E按教育程度进行分层分析；F按饮酒史进行分层分析；G按吸烟史进行分层分析；H按糖尿病病史进行分层分析；I按高血压病史进行分层分析。

, figureFileSmall=Y5OsP12NnMuVWsnsEMd4TA==, figureFileBig=GAgwJKGMXqN+n7f3XaaOOQ==, tableContent=null), ArticleFig(id=1324071025767493757, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=EN, label=Table 1, caption=

Baseline characteristics of included participants based on quartile of CALLY

, figureFileSmall=null, figureFileBig=null, tableContent=
特征CALLY指数四分位数t/x2值P值
Q1Q2Q3Q4
年龄[岁，n（%）]39.547<0.001
>60912（27.4）836（25.1）767（22.2）525（14.2）
18~601 536（72.6）1 613（74.9）1 681（77.8）1 921（85.8）
性别[n（%）]48.233<0.001
男990（37.5）1 148（46.3）1 331（54.3）1 343（54.3）
女1 458（62.5）1 301（53.7）1 117（45.7）1 103（45.7）
种族[n（%）]8.213<0.001
白人1 136（67.5）1 151（69.0）1 153（68.9）1 233（69.9）
墨西哥裔441（9.3）502（9.7）485（9.3）371（7.1）
黑人533（14.0）425（10.5）408（9.5）382（8.4）
其他338（9.2）371（10.8）402（12.3）460（14.6）
教育程度[n（%）]3.6860.004
大学及以上1 696（78.5）1 725（80.7）1 735（80.8）1 843（84.0）
中学和高中449（15.0）413（13.0）391（12.4）359（10.8）
小学及以下303（6.5）311（6.3）322（6.8）244（5.2）
婚姻状况[n（%）]10.711<0.001
已婚1 233（54.5）1 310（57.4）1 369（58.6）1 252（55.7）
从未结婚373（16.1）378（15.8）398（17.1）581（22.8）
与伴侣同居184（7.5）184（7.1）188（7.5）216（8.3）
其他658（21.9）577（19.7）493（16.8）397（13.2）
BMI[kg/m2, n（%）]117.771<0.001
>301 445（59.6）1 101（42.9）744（28.2）324（12.3）
>25.00～30.00641（25.9）852（34.9）993（39.6）856（34.1）
18.50～25.00349（14.0）478（21.5）678（30.8）1 177（49.7）
<18.5013（0.5）18（0.7）33（1.4）89（3.9）
吸烟[n（%）]0.0790.978
是537（21.3）534（21.7）534（21.7）555（21.2）
否1 911（78.7）1 915（78.3）1 914（78.3）1 891（78.8）
饮酒[n（%）]15.198<0.001
既往饮酒534（19.0）460（16.5）381（13.2）306（10.1）
当前饮酒1 565（68.6）1 672（73.3）1 773（77.2）1 883（81.0）
从不饮酒349（12.4）317（10.2）294（9.6）257（8.9）
RA[n（%）]28.939<0.001
是239（8.0）150（4.2）122（3.4）79（2.3）
否2 209（92.0）2 299（95.8）2 326（96.6）2 367（97.7）
高血压[n（%）]46.963<0.001
是1 058（39.6）849（31.0）749（26.7）527（17.8）
否1 390（60.4）1 600（69.0）1 709（73.3）1 919（82.2）
糖尿病[n（%）]19.691<0.001
是369（12.1）265（7.3）245（6.3）171（5.2）
否2 079（87.9）2 184（92.7）2 203（93.7）2 277（94.8）
CRP[mg/L，M（P25, P75）]8.3（5.5,13.2）2.8（2.1,3.7）1.2（0.9,1.6）0.4（0.2,0.6）3.000<0.001
CALLY[M（P25, P75）]100（61,140）312（246,383）718（578,902）2 214（1 584,3 760）3.000<0.001
ALB[g/L，M（P25, P75）]40（38,43）42（40,44）43（42,45）44（43,46）3.000<0.001
), ArticleFig(id=1324071025838796926, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=CN, label=表1, caption=

根据CALLY四分位数得出的入选者基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征CALLY指数四分位数t/x2值P值
Q1Q2Q3Q4
年龄[岁，n（%）]39.547<0.001
>60912（27.4）836（25.1）767（22.2）525（14.2）
18~601 536（72.6）1 613（74.9）1 681（77.8）1 921（85.8）
性别[n（%）]48.233<0.001
男990（37.5）1 148（46.3）1 331（54.3）1 343（54.3）
女1 458（62.5）1 301（53.7）1 117（45.7）1 103（45.7）
种族[n（%）]8.213<0.001
白人1 136（67.5）1 151（69.0）1 153（68.9）1 233（69.9）
墨西哥裔441（9.3）502（9.7）485（9.3）371（7.1）
黑人533（14.0）425（10.5）408（9.5）382（8.4）
其他338（9.2）371（10.8）402（12.3）460（14.6）
教育程度[n（%）]3.6860.004
大学及以上1 696（78.5）1 725（80.7）1 735（80.8）1 843（84.0）
中学和高中449（15.0）413（13.0）391（12.4）359（10.8）
小学及以下303（6.5）311（6.3）322（6.8）244（5.2）
婚姻状况[n（%）]10.711<0.001
已婚1 233（54.5）1 310（57.4）1 369（58.6）1 252（55.7）
从未结婚373（16.1）378（15.8）398（17.1）581（22.8）
与伴侣同居184（7.5）184（7.1）188（7.5）216（8.3）
其他658（21.9）577（19.7）493（16.8）397（13.2）
BMI[kg/m2, n（%）]117.771<0.001
>301 445（59.6）1 101（42.9）744（28.2）324（12.3）
>25.00～30.00641（25.9）852（34.9）993（39.6）856（34.1）
18.50～25.00349（14.0）478（21.5）678（30.8）1 177（49.7）
<18.5013（0.5）18（0.7）33（1.4）89（3.9）
吸烟[n（%）]0.0790.978
是537（21.3）534（21.7）534（21.7）555（21.2）
否1 911（78.7）1 915（78.3）1 914（78.3）1 891（78.8）
饮酒[n（%）]15.198<0.001
既往饮酒534（19.0）460（16.5）381（13.2）306（10.1）
当前饮酒1 565（68.6）1 672（73.3）1 773（77.2）1 883（81.0）
从不饮酒349（12.4）317（10.2）294（9.6）257（8.9）
RA[n（%）]28.939<0.001
是239（8.0）150（4.2）122（3.4）79（2.3）
否2 209（92.0）2 299（95.8）2 326（96.6）2 367（97.7）
高血压[n（%）]46.963<0.001
是1 058（39.6）849（31.0）749（26.7）527（17.8）
否1 390（60.4）1 600（69.0）1 709（73.3）1 919（82.2）
糖尿病[n（%）]19.691<0.001
是369（12.1）265（7.3）245（6.3）171（5.2）
否2 079（87.9）2 184（92.7）2 203（93.7）2 277（94.8）
CRP[mg/L，M（P25, P75）]8.3（5.5,13.2）2.8（2.1,3.7）1.2（0.9,1.6）0.4（0.2,0.6）3.000<0.001
CALLY[M（P25, P75）]100（61,140）312（246,383）718（578,902）2 214（1 584,3 760）3.000<0.001
ALB[g/L，M（P25, P75）]40（38,43）42（40,44）43（42,45）44（43,46）3.000<0.001
), ArticleFig(id=1324071025901711487, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=EN, label=Table 2, caption=

Results from logistic regression analysis

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CALLY模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
CALLY
Q1RefRefRef
Q20.61（0.49～0.75）<0.0010.68（0.55～0.85）<0.0010.71（0.57～0.89）<0.01
Q30.48（0.39～0.61）<0.0010.60（0.47～0.76）<0.0010.63（0.49～0.80）<0.001
Q40.31（0.24～0.40）<0.0010.46（0.35～0.62）<0.0010.49（0.37～0.65）<0.001
P for trend<0.001<0.001<0.001
), ArticleFig(id=1324071025973014656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324071016913317964, language=CN, label=表2, caption=

logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
CALLY模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
CALLY
Q1RefRefRef
Q20.61（0.49～0.75）<0.0010.68（0.55～0.85）<0.0010.71（0.57～0.89）<0.01
Q30.48（0.39～0.61）<0.0010.60（0.47～0.76）<0.0010.63（0.49～0.80）<0.001
Q40.31（0.24～0.40）<0.0010.46（0.35～0.62）<0.0010.49（0.37～0.65）<0.001
P for trend<0.001<0.001<0.001
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丁一航 1 , 王露盈 1 , 卢斯仪 1 , 侯秀娟 2
现代预防医学 | 临床与预防 2025,52(24): 4584-4590
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现代预防医学 |临床与预防 2025 , 52 (24) : 4584 -4590
C反应蛋白-白蛋白-淋巴细胞指数与类风湿关节炎的相关性研究：基于NHANES的横断面研究
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丁一航1, 王露盈1, 卢斯仪1, 侯秀娟2
作者信息
  • 1.北京中医药大学第二临床医学院，北京　100029
  • 2.北京中医药大学东方医院风湿科
通讯作者:
侯秀娟，E-mail：
作者简介:

丁一航（2001—），女，硕士在读，研究方向：风湿免疫病的中医药防治

Correlation of C-reactive protein-albumin-lymphocyte index with rheumatoid arthritis: a cross-sectional NHANES-based study
Yi-hang DING1, Lu-ying WANG1, Si-yi LU1, Xiu-juan HOU2
Affiliations
  • School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
出版时间: 2025-12-25 doi: 10.20043/j.cnki.MPM.202507178
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摘要
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目的

分析C反应蛋白-白蛋白-淋巴细胞（The C-reactive protein-albumin-lymphocyte，CALLY）指数在一般人群中作为类风湿关节炎（Rheumatoid arthritis，RA）患病风险预测因子的价值。

方法

纳入了2007年至2018年美国全国健康和营养检查调查（NHANES）9 791名参与者的数据。计算CALLY 指数，采用多种模型来研究和评估CALLY 与RA之间的关联。

结果

与CALLY最低四分位数（Q1）相比，Q2组患类风湿关节炎的OR=0.71（95% CI：0.57～0.89），Q3组OR=0.63（95% CI：0.49～0.80），Q4组OR=0.49（95% CI：0.37～0.65）。CALLY 指数与RA之间存在显著的非线性关系（P <0.001）。

结论

CALLY指数与类风湿关节炎患病风险之间存在着显著的负相关性。

类风湿关节炎  /  CALLY  /  炎症  /  NHANES
Objective

To analyze the value of the C-reactive protein-albumin-lymphocyte (CALLY) index as a predictor of rheumatoid arthritis (RA) risk in the general population.

Methods

Data from 9 791 participants in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included. The CALLY index was calculated, and multiple models were used to investigate and evaluate the association between CALLY and RA.

Results

Compared to the lowest quartile (Q1) of the CALLY index, the odds ratio (OR) for RA were 0.71 (95% CI: 0.57-0.89) for Q2, 0.63 (95% CI: 0.49-0.80) for Q3, and 0.49 (95% CI: 0.37-0.65) for Q4. A significant non-linear relationship existed between the CALLY index and RA (P<0.001).

Conclusion

The CALLY index demonstrates a significant negative correlation with the risk of rheumatoid arthritis.

Rheumatoid arthritis  /  CALLY  /  Inflammation  /  NHANES
丁一航, 王露盈, 卢斯仪, 侯秀娟. C反应蛋白-白蛋白-淋巴细胞指数与类风湿关节炎的相关性研究：基于NHANES的横断面研究. 现代预防医学, 2025 , 52 (24) : 4584 -4590 . DOI: 10.20043/j.cnki.MPM.202507178
Yi-hang DING, Lu-ying WANG, Si-yi LU, Xiu-juan HOU. Correlation of C-reactive protein-albumin-lymphocyte index with rheumatoid arthritis: a cross-sectional NHANES-based study[J]. Modern Preventive Medicine, 2025 , 52 (24) : 4584 -4590 . DOI: 10.20043/j.cnki.MPM.202507178
正文
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类风湿关节炎（Rheumatoid arthritis，RA）是一种主要影响关节的系统性自身免疫性炎症性疾病。全球类风湿关节炎的患病率约为0.25%～1%，任何年龄的人都有可能罹患类风湿关节炎，40岁以上人群的发病率更高，而女性的患病率是男性的2～3倍[1-2]。类风湿关节炎可导致严重的关节损伤和残疾，对个人和社会都造成了沉重的负担[3-4]。病理生理学研究表示，类风湿关节炎的发生和发展与自身免疫反应失衡和炎症反应相关[4]。C反应蛋白-白蛋白-淋巴细胞（C-reactive protein -Albumin-lymphocyte，CALLY）指数是一种新的免疫营养评分系统。白蛋白可以评估营养状况，淋巴细胞计数能够反映机体免疫状态，C反应蛋白是典型的炎症标志物。目前，CALLY指数已被证明是接受肝细胞癌（Hepatocellular carcinoma，HCC）切除术后患者的预后指标，且与直肠癌患者预后相关[5-6]。有研究表明，CALLY指数可能与已确诊RA患者的疾病活动度相关，提示其可能作为一种炎症预后标志物[7]。然而，关于CALLY指数在一般人群中与RA患病风险之间相关性的研究尚不充分。因此，本研究利用来自美国全国健康和营养检查调查（the National Health and Nutrition Examination Survey，NHANES）的数据，探讨了CALLY指数和RA患病之间的关联，以期为人群识别RA的风险因素提供新的数据支持。
1　材料与方法
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1.1　数据来源和研究人群
NHANES是一项具有全国代表性的定期横断面抽样调查，调查评估了美国人口中成人和儿童的健康和营养状况。NHANES获得美国国家卫生统计中心（the National Center for Health Statistics，NCHS）伦理审查委员会的批准，所有参与者在招募时都提供了书面同意。本研究调查了2007年到2018年的相关数据，排除了24 163名年龄小于18岁的受试者，3 924名缺少关节炎数据的受试者，以及21 964名基线CRP、白蛋白或淋巴细胞计数任一指标数据缺失的受试者，该研究最终纳入了9 791名参与者。
1.2　CALLY指数计算
参照如下公式计算CALLY指数：
1.3　类风湿性关节炎的评估
类风湿关节炎的诊断通过自我报告问卷（MCQ160a）来确定。参与者被问及“是否有医生或其他健康专业人员曾告诉过你，你患有关节炎？”对于类风湿关节炎的评估，进一步询问“是哪种类型的关节炎？”选项包括“类风湿关节炎”、“骨关节炎”、“银屑病性关节炎”、“其他”、“拒绝回答”和“不知道”。自我报告为“类风湿关节炎”的受试者被定义为RA病例。报告为“骨关节炎”、“银屑病性关节炎”或“其他”的受试者被定义为非RA病例。回答“拒绝回答”或“不知道”的受试者予以排除。
1.4　协变量评估
协变量的纳入是基于现有文献和临床考虑。人口统计学因素包括年龄、性别、BMI、种族、教育程度和婚姻状况。此外，还考虑了吸烟、饮酒、高血压和糖尿病等危险因素。有关变量收集方法的详细信息，请参阅NHANES调查方法和分析指南[8]。
1.5　统计分析
所有分析均使用R（4.2.2版）进行，连续变量若符合正态分布，采用描述，否则采用M（P25, P75）描述；分类变量采用百分比描述。对于基线特征，使用卡方检验比较分类变量，使用t检验或单因素方差分析比较连续变量。采用多变量logistic回归模型研究CALLY与类风湿性关节炎之间的关联，模型1未针对任何协变量进行调整，模型2调整了年龄、性别、BMI、种族、教育和婚姻，模型3进一步调整了年龄、性别、BMI、种族、教育、婚姻、吸烟、饮酒、高血压和糖尿病。利用限制性立方样条（Restricted cubic spline，RCS）来研究CALLY指数和RA之间潜在的非线性关系，基于Harrell的建议，节点位置预设于第5、35、65、95百分位数。为确定最佳自由度，本研究拟合了节点数k=3至k=5的模型，并通过Akaike信息准则（AIC）进行比较，最终选择AIC值最小的模型（k=4，即3个自由度），该模型在拟合优度与简洁性之间达到了最佳平衡。非线性关系通过似然比检验（比较包含样条项的完整模型与仅含线性项的简化模型）进行评估。检验水准α=0.05。
2　结果
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2.1　基线特征
本研究共纳入了9 791名参与者，CALLY指数的基线特性如表1所示。CALLY四分位数之间在年龄、性别、种族、婚姻状况、BMI、饮酒、类风湿关节炎、高血压、糖尿病和CRP数值方面存在显著差异（P<0.001）。
2.2　CALLY 指数和 RA的关系
结果表明，较高的CALLY水平与RA风险降低之间存在很强的相关性（表2）。与最低组相比，在完全调整模型中的风险降低了51%，OR=0.49，95% CI：0.37~0.65。此外，RCS分析（调整或未调整）揭示了CALLY指数与RA之间存在显著的非线性关联（图1）。
2.3　亚组分析
对年龄、性别、BMI、种族、婚姻状况、教育水平、吸烟、饮酒、高血压和糖尿病等因素进行了亚组分析（图2）。交互作用测试结果显示，CALLY指数与RA之间的关系在种族方面存在统计学上的显著差异（P为交互作用<0.05），这表明种族可能对这种关联有显著影响。
3　讨论
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本研究基于NHANES数据库中9 791名成年人的横断面数据，系统性地探讨了CALLY指数与RA患病风险之间的关联。研究结果表明，CALLY指数与RA患病风险之间存在着显著的负相关，在调整了各种混杂因素后，这种负相关性仍然存在。CALLY指数作为一个新型、综合的指标，可以用于RA的患病风险评估和早期识别。
3.1　CALLY指数在RA病理生理中的理论基础
CALLY指数作为是一种新型炎症指数，由白蛋白水平、淋巴细胞计数和CRP组成[9]，这三个指标在RA的病理生理过程中有着重要的作用，也是对“炎症-免疫-营养”这一网络的综合评估。血清蛋白（包括白蛋白）在维持营养和调节渗透压方面起着重要作用，是人体血浆中最重要的蛋白质，近年的研究还揭示其具有抗炎、抗氧化及免疫调节的功能[10]。血清白蛋白与RA疾病活动之间存在关联，它在急性炎症反应期间表现出较低的水平，而血清白蛋白的降低可能是RA的危险因素之一，也是RA发展的结局之一[11-15]。具体来说，在炎症状态下，白细胞介素-6（Interleukin-6，IL-6）、肿瘤坏死因子-α（Tumor necrosis factor，TNF-α）等细胞因子会抑制肝脏对白蛋白的合成，同时增加其分解代谢和血管通透性，导致白蛋白的外渗[16-17]。因此，RA患者的低白蛋白血症是全身性炎症反应的结果，也更说明了白蛋白这一指标对RA病情评估的重要性。淋巴细胞在RA的免疫失调中占据中心地位，特别是辅助性T细胞17/ Treg细胞（T helper 17 cell / Regulatory T cell，Th17/Treg）平衡的打破、B细胞的自身抗体产生及细胞毒性T细胞的异常活化，共同造成了滑膜炎和关节损伤[18]。研究中观察到的淋巴细胞计数降低在活动性RA患者中并不少见，其机制复杂，可能包括炎症介质诱导的细胞凋亡、免疫细胞向炎性关节组织的重新分布（“归巢”效应），以及某些治疗药物（如糖皮质激素、甲氨蝶呤）的影响[19-20]。淋巴细胞计数的减少，尤其调节性T细胞（Regulatory T cells，Tregs）等关键免疫抑制亚群细胞的失能，将导致免疫耐受的破坏和自身反应性淋巴细胞的失控，从而致使炎症迁延不愈[4,21]。CRP是一种可以评估RA全身炎症的标志物，在RA中，持续的滑膜炎导致大量的促炎细胞因子释放入血，引起CRP水平的升高[4]。越来越多的临床证据表明，CRP可能在RA的骨破坏中起直接作用，但RA的活动度评估仍需结合其他指标[22]。总的来说，CALLY指数通过整合营养、免疫及炎症三大路径，提供了一个多维度、综合性的评估工具，能够更灵敏地反映RA早期的病理生理变化。
3.2　种族差异与对RA患病风险的影响
在我们的研究中，交互作用测试结果显示，种族可能与RA发病之间存在着显著的关联。遗传背景的差异是RA易感性的关键决定因素，遗传学研究已明确主要组织相容性复合体Ⅱ类DRβ1链基因（ Major Histocompatibility Complex, Class II, DR Beta 1，HLA-DRB1）与RA发病强烈相关，而非白人人群（如非洲裔、拉丁裔）的等位基因频率与白人存在显著差异[23]。有研究发现，在北半球从北到南以及从城市到农村地区RA患病率明显减少，而一些美洲原住民人口的患病率非常高[24-25]。具有RA阳性家族史的人患RA的风险会增加大约3～5倍，而双胞胎中患病风险的一致性增加，也表明了发病机制中存在遗传因素的影响[4,18]。目前研究估计，血清阳性类RA的遗传率为40～65%，但血清阴性的RA遗传率较低（20%）[26-27]。另外，环境暴露与社会经济因素也与种族密切相关，包括饮食习惯、吸烟率、维生素D水平、感染病史以及医疗可及性等，这些因素均可影响个体的基础炎症水平和免疫营养状态，进而可能影响CALLY指数与RA患病风险之间的关联强度[28-29]。这也提示我们，在未来的临床应用和风险模型构建中，需要考虑种族的特异性影响。
3.3　CALLY指数在RA诊断和评估中的应用前景
在当前的临床实践中，RA的诊断和评估大多依赖于特异性自身抗体，如类风湿因子（Rheumatoid factor, RF）和抗环瓜氨酸肽抗体（Anti-cyclic citrullinated peptide antibody，ACPA）以及疾病活动度评分（如DAS28）。CALLY指数作为一个非特异性的综合指标，在一定程度上可以对RA的诊断和评估进行补充。相较于RF和ACPA，CALLY指数的三个组成部分均为最常规的血常规和生化检查项目，成本较低，易于获取，容易普及。对于出现非特异性关节疼痛但尚未明确诊断的“临床疑似关节炎”人群，CALLY指数可作为一个初步的、便捷的风险分层工具。一个异常低的CALLY指数值，即使在RF/ACPA结果未知或阴性的情况下，患者也可能存在全身性的炎症免疫紊乱，从而帮助RA的早期识别和干预。虽然目前已有包含CRP的RA疾病活动度评分，但CALLY额外整合了反映营养和免疫状态的白蛋白与淋巴细胞，能够更加全面地反映治疗对整个机体状态的改善情况。因此，监测CALLY指数的动态变化，也许能为疗效的评估和患者长期预后情况的判断提供新的视角。
本研究使用横断面研究方法探讨了CALLY与RA患病风险的关联，并通过采用NHANES的复杂多阶段概率抽样设计，增加了研究结果的代表性。同时，本研究对协变量进行了恰当的调整，提升了研究数据的可信度。然而，我们的研究仍然存在一定的局限性，首先本研究为回顾性研究，不能完全排除潜在的偏倚，并且横断面研究设计限制了对因果关系的推断能力。其次本研究中RA的诊断依赖于患者的自我报告，这可能存在回忆偏倚或误诊的情况，可能对效应估计值造成偏倚。因此，未来还需要前瞻性研究来明确CALLY指数和RA之间的纵向关系，深入评估CALLY指数的预测效能和实际应用价值。总之，本研究揭示了CALLY指数与RA之间有着显著的负相关性，它展现了作为RA潜在风险评估工具的价值。
本研究揭示了CALLY指数与类风湿关节炎患病风险之间存在着显著的负相关性。这一发现不仅为深入了解RA的病理生理学特征提供了新的视角，也展现了CALLY指数作为一个具有潜力的、低成本的RA风险评估工具的价值，但这一结果，也需要未来的前瞻性研究和临床试验来验证。
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  • 北京中医药大学基本科研业务费(揭榜挂帅项目2023-JYB-JBZD-008)
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2025年第52卷第24期
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doi: 10.20043/j.cnki.MPM.202507178
  • 接收时间：2025-07-11
  • 首发时间：2026-11-02
  • 出版时间：2025-12-25
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  • 收稿日期：2025-07-11
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北京市自然科学基金面上项目(7242229)
北京中医药大学基本科研业务费(揭榜挂帅项目2023-JYB-JBZD-008)
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    1.北京中医药大学第二临床医学院，北京　100029
    2.北京中医药大学东方医院风湿科

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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