目的 探讨类风湿关节炎（rheumatoid arthritis， RA）患者血清细胞凋亡相关斑点样蛋白（apoptosis-associated speck-like protein， PYCARD）、核因子κB受体活化因子配体（nuclear factor κB receptor activator ligand， RANKL）、壳多糖酶3样蛋白1（chitinase 3-like protein 1， CHI3L1）表达及其与疾病活动度的关系。 方法 选取安庆市立医院2021年1月至2025年12月收治的104例RA患者（RA组）进行研究，按照28个关节疾病活动度评分（DAS28）分为缓解组（51例）与活动组（53例），另选取同期52例健康志愿者（对照组）。比较RA组与对照组、缓解组和活动组血清PYCARD、RANKL、CHI3L1表达水平，分析三者表达水平与DAS28评分的相关性及其联合检测对RA疾病活动度的评估价值。 结果 RA组血清PYCARD、RANKL、CHI3L1表达水平较对照组高（P < 0.05）。活动组血清PYCARD、RANKL、CHI3L1表达水平较缓解组高（P < 0.05）。血清PYCARD、RANKL、CHI3L1表达水平与DAS28评分呈正相关（r = 0.579、0.534、0.602，P < 0.05）。血清PYCARD、RANKL、CHI3L1联合检测对RA疾病活动度评估价值的诊断曲线下面积（AUC）值为0.898，三者单独检测AUC值分别为0.743、0.730、0.767，联合检测显著高于单独检测（P < 0.05），且联合检测的敏感度为92.45%，特异度为84.31%。 结论 PYCARD、RANKL、CHI3L1表达水平与RA发病及其疾病活动度相关，PYCARD、RANKL、CHI3L1联合检测具有协同诊断优势，对RA疾病活动度评估价值较高，能为临床RA患者的疾病活动状态提供更客观、准确的评估手段。

Objective To investigate the expression levels of apoptosis-associated speck-like protein （PYCARD）， nuclear factor κB receptor activator ligand （RANKL）， and chitinase 3-like protein 1 （CHI3L1） in the serum of patients with rheumatoid arthritis （RA）， and to explore the relationship between these proteins and disease activity. Methods A total of 104 patients with rheumatoid arthritis （RA group） who were admitted to Anqing Municipal Hospital from January 2021 to December 2025 were recruited for this study. They were divided into the remission group （51 cases） and the active group （53 cases） based on the 28-joint disease activity score （DAS28）. Additionally， 52 healthy volunteers （control group） were recruited during the same period. The expression levels of serum PYCARD， RANKL， and CHI3L1 were compared between the RA group and the control group， as well as between the remission group and the active group. Moreover， the correlation between the expression levels of these three markers and the DAS28 score was analyzed， along with the evaluation value of the combined detection of serum PYCARD， RANKL， and CHI3L1 for the disease activity of RA. Results In the RA group， the expression levels of serum PYCARD， RANKL， and CHI3L1 were significantly higher than those in the control group （P < 0.05）. In the active group， the expression levels of serum PYCARD， RANKL， and CHI3L1 were significantly higher than those in the remission group （P < 0.05）. The expression levels of serum PYCARD， RANKL， and CHI3L1 were positively correlated with the DAS28 score （r = 0.579， 0.534， 0.602， P < 0.05）. The area under the curve （AUC） value of the combined detection of serum PYCARD， RANKL， and CHI3L1 for the evaluation of RA disease activity was 0.898. The AUC values of the three individual tests were 0.743， 0.730， and 0.767， respectively. The AUC value of the combined detection was significantly higher than those of the individual detections （P < 0.05）. The sensitivity and specificity of the combined detection were 92.45% and 84.31%， respectively. Conclusions The expression levels of PYCARD， RANKL， and CHI3L1 are related to the onset of RA and its disease activity. The combined detection of PYCARD， RANKL， and CHI3L1 has the advantage of collaborative diagnosis and is of high value in evaluating the disease activity of RA， providing a more objective and accurate assessment method for the disease activity status of clinical RA patients.