修订分类标准诊断血清学阴性与阳性类风湿关节炎临床特征的比较

发布时间：2018-03-17 01:40

本文选题：关节炎　切入点：类风湿　出处：《东南大学学报(医学版)》2016年05期 　论文类型：期刊论文

【摘要】：目的:探讨2010年ACR/EULAR修订的类风湿关节炎(RA)分类标准诊断的血清学阴性与阳性RA患者临床特征差异。方法:选取57例血清学阴性RA患者和240例血清学阳性RA患者,分析两组性别、起病年龄、病程、确诊时间、受累关节部位、关节数、DAS28评分及并发症情况,比较两组患者的治疗方案及疗效。结果:(1)血清学阴性组平均病程(47.58±26.43)个月,确诊时间(33.71±21.56)个月,血清阴性组女性患者占43%。(2)血清学阴性组总受累关节数(13.35±8.21)个,受累小关节数(9.94±6.30)个;其中膝关节占14.10%,肘关节18.73%,踝关节19.29%,掌指关节14.47%,近段指间关节15.21%,腕关节14.10%。(3)血清学阴性组出现肺间质病变占21.05%,肺动脉高压17.54%,心包积液5.3%。(4)血清学阴性组血红蛋白(Hb)质量浓度(108.28±16.94)g·L-1,血小板计数(PLT)(284.87±91.51)×109L-1,球蛋白(Glo)质量浓度(33.70±11.75)g·L-1,C反应蛋白(CRP)质量浓度(38.06±40.75)mg·L-1,红细胞沉降率(ESR)(58.63±38.76)mm·h-1,DAS28评分(5.65±1.35)分。(5)血清学阴性组57例患者中使用糖皮质激素46例,抗骨质疏松药33例,植物药51例,治疗后Glo下降(10.84±9.56)g·L-1,ESR下降(31.05±29.51)mm·h-1,CRP下降(28.85±35.87)mg·L-1,DAS28评分下降(1.79±1.00)分。结论:应用修订RA分类标准可对血清阴性患者进行早诊断。此类患者受累关节数及小关节少;关节外病变少;Hb水平高,PLT、Glo、CRP、ESR水平及DAS28评分低,对于强度较低的治疗方案效果好。
[Abstract]:Objective: to investigate the difference of clinical features between seronegative and positive RA diagnosed by ACR/EULAR 's revised classification criteria of rheumatoid arthritis (RA) in 2010. Methods: 57 patients with sero-negative RA and 240 patients with seropositive RA were selected to analyze the sex of the two groups. Age of onset, course of disease, time of diagnosis, site of affected joint, number of joints, DAS28 score and complications were compared between the two groups. Results the average course of disease was 47.58 卤26.43 months and the time of diagnosis was 33.71 卤21.56 months in sero-negative group. The total number of involved joints in sero-negative group was 13.35 卤8.21, and the number of involved facet joints was 9.94 卤6.30; Of these, 14.10% of the knee involved, 18.73 of the elbow, 19.29 of the ankle, 14.47 of the metacarpophalangeal joint, 15.21 of the proximal interphalangeal joint, 14.10.10 of the wrist and 14.10 of the wrist.) in the sero-negative group, pulmonary interstitial lesions occurred in 21.05%, pulmonary hypertension 17.54, pericardial effusion 5.33.4) hemoglobin (HB) in the sero-negative group. The concentration of CRP was 38.06 卤40.75mg 路L -1, and the erythrocyte sedimentation rate was 58.63 卤38.76 mm 路h-1DAS28, 5.65 卤1.35). In the serological group, 46 cases of glucocorticoid were used in the 57 cases of negative serological group, and the platelet count was 284.87 卤91.51 脳 10 9L -1 and 33.70 卤11.75 g 路L -1 C reactive protein (CRP) concentration was 38.06 卤40.75 mg 路L -1, and the erythrocyte sedimentation rate was 58.63 卤38.76 mm 路h -1 DAS28 score of 5.65 卤1.35) in the serological group, 46 cases were treated with glucocorticoid. There were 33 cases of anti-osteoporosis drugs and 51 cases of plant drugs. After treatment, the Glo decreased by 10.84 卤9.56 g 路L -1 Glo and decreased by 31.05 卤29.51 mm 路h-1g 路h -1 CRP decreased by 28.85 卤35.87 mg 路L -1 DAS28 scores and 1.79 卤1.00. Conclusion: the modified RA classification criteria can be used for early diagnosis of seronegative patients, the number of joints involved and the number of small joints in these patients are lower. The level of HB in extraarticular lesions was high and the level of CRP ESR and DAS28 score were low, which was effective for the treatment of low intensity.
【作者单位】：桂林医学院附属医院风湿免疫科;
【基金】：国家自然科学基金资助项目(1460257) 广西壮族自治区自然科学基金资助项目(2013GXNSFBA019181) 广西壮族自治区卫生厅自筹经费科研项目(Z2012425)
【分类号】：R593.22

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