30例血清学阴性类风湿关节炎临床及免疫学特点分析

发布时间：2018-03-18 03:16

本文选题：关节炎　切入点：类风湿　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨血清学阴性类风湿关节炎患者临床表现、实验室检验及影像学检查特点。方法回顾2005年10月-2016年8月宁夏医科大学总医院确诊为类风湿关节炎(RA)的住院患者,等距收集249例。其中RF、ANA、ENA、AKA、CCP检测均为阴性的RA患者30例(血清学阴性RA),同期上述5个指标中至少一个为阳性的RA患者219例(血清学阳性RA)。分析两组患者的临床表现及实验室检查结果的差异性。结果1、⑴血清学阴性RA女性晨僵率高于血清学阴性RA男性(68.42%比18.18%,P=0.008)及血清学阳性RA女性(68.42%比62.89%,P=0.036)。⑵血清学阴性RA男性晨僵率低于血清学阳性RA男性(18.18%比61.67%,P=0.020),晨僵时间短于血清学阴性RA女性(min:0比30,P=0.014),晨僵时间短于血清学阳性RA男性(min:0比20,P=0.011)。2、血清学阴性RA女性首发症状存在大关节痛的比例高于血清学阳性RA女性(78.95%比76.73%,P=0.014),出现功能障碍比例低于血清学阳性RA女性(26.31%比52.83%,P=0.039)。3、⑴血清学阴性RA患者血红蛋白水平高于血清学阳性RA(g/L:129.00000比121.0000,P=0.002)。血清学阴性RA女性血红蛋白水平低于血清学阴性RA男性(g/L:124.00比142.00,P=0.001)。血清学阴性RA女性血红蛋白水平高于血清学阳性RA女性(g/L:124.00比116.00,P=0.003)。⑵血清学阴性RA血沉水平低于血清学阳性RA(mm/h:29.00比42.00,P=0.035),IgG水平低于血清学阳性RA(g/L:11.25比14.80,P=0.001),C4水平高于血清学阳性RA(g/L:0.25700比0.21700,P=0.009)。血清学阴性RA女性血沉水平低于血清学阳性RA女性(mm/h:33.00比44.00,P=0.028),CRP水平低于血清学阴性RA男性(mm/h:3.70000比39.80,P=0.012),CRP水平低于血清学阳性RA女性(mm/h:3.70000比18.70,P=0.018)。血清学阴性RA女性IgG水平低于血清学阳性RA女性(g/L:11.40比15.30,P=0.001),IgM水平高于血清学阴性RA男性(g/L:1.30比0.83,Z=-2.964,P=0.003)。血清学阴性RA男性IgM水平低于血清学阳性RA男性(g/L:0.83比1.30,P=0.018),C4水平高于血清学阳性RA男性(g/L:0.333比0.2515,P=0.024)。⑶血清学阴性RA出现关节III期改变比例高于血清学阳性RA(33.33%比12.32%,P=0.006)。血清学阴性RA男性关节III期改变的比例高于血清学阳性RA男性(54.55%比5.00%,P=0.001)。⑷血红蛋白与血沉、IgG及C4水平呈负相关,IgG与血沉呈正相关,与C4水平呈负相关。结论1、血清学阴性RA患者贫血程度轻,炎症程度较低,更易出现骨侵蚀。2、血清学阴性RA男性患者IgG水平低、C4水平高。3、血清学阴性RA女性患者晨僵持续时间长、首发症状中大关节痛发生率高,关节功能障碍发生少。
[Abstract]:Objective to investigate the clinical manifestations, laboratory tests and imaging features of patients with sero-negative rheumatoid arthritis (RA). Methods the hospitalized patients with rheumatoid arthritis (RA) diagnosed in the General Hospital of Ningxia Medical University from October 2005 to August 2016 were retrospectively reviewed. A total of 249 patients were collected at isometric intervals. 30 patients (seronegative rags) were found in 30 RA patients (seronegative rags), and at least one of the above five markers was positive in 219 patients (serologically positive rags). The clinical manifestations and clinical manifestations of the two groups were analyzed. Results 1the morning stiffness rate of sero-negative RA women was higher than that of sero-negative RA males (68.42% vs 18.18g P0.008) and seropositive RA women (68.42% vs 62.89g / 0.036.2%). The duration of morning stiffness was shorter than that of sero-negative RA women, and the morning stiffness time was shorter than that of seropositive RA women. The morning stiffness time was shorter than that of seropositive RA males. The incidence of significant arthralgia in sero-negative RA women was higher than that in seropositive RA women. The hemoglobin level of seropositive RA women was lower than that of seropositive RA women (26.31% vs 52.83% vs 52.83%). The hemoglobin level of seropositive RA women was higher than that of seropositive RA(g/L:129.00000 patients than that of seropositive RA women. The hemoglobin level of sero-negative RA women was lower than that of sero-negative RA women. The hemoglobin level of sero-negative RA women was higher than that of seropositive RA women (124.00: 116.00 P0. 003.2). The ESR level of seropositive RA was lower than that of serologically positive RA(mm/h:29.00 (42.00P0.03535). The level of ESR in sero-negative RA women was lower than that in seropositive RA women (3.70000 vs 18.70000 vs 18.70P0.018). The IgG level in sero-negative RA women was lower than that in sero-negative RA women. The level of IgM in seropositive RA women was lower than that in seropositive RA women (g / L = 15.30: 15.30 / 15.30: 0.001). The level of IgM in seropositive RA women was lower than that in seropositive RA women (g / L = 15.30 / 15.30). The level of IgM in seropositive RA women was higher than that in seropositive RA men (g / L = 0.2515P0.024.3 / 0.2515P0.024.3), and the level of IgM in seropositive RA women was higher than that in seropositive RA men (g / L = 0.2515P 0.024.3). The incidence of joint III phase changes in seropositive RA patients was higher than that in seropositive RA patients (33.33% vs 12.32% vs 12.32%). The incidence of joint III phase changes in sero-negative RA men was higher than that in seropositive RA men (54.55% vs 5.00%). There was a positive correlation between IgG and ESR. Conclusion 1.The anemia degree and inflammation degree of sero-negative RA patients are lower than those of sero-negative RA patients. Bone erosion was more likely to occur in sero-negative RA male patients with lower IgG level and higher C4 level. The duration of morning stiffness in sero-negative RA women was longer. The incidence of major arthralgia and joint dysfunction were high in the initial symptoms.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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