血清RF与CCP阴性的类风湿关节炎患者临床特点分析

发布时间：2018-06-23 04:49

  本文选题：抗环瓜氨酸肽抗体 + 类风湿因子　； 参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的通过对血清类风湿因子(RF)与抗环瓜氨酸肽抗体(CCP)阴性的类风湿关节炎(RA)患者的临床特点、实验室指标及影像学检查进行分析,提高对RF与CCP阴性的RA患者的认识。方法回顾性调查2011年6月-2016年6月于宁夏医科大学总医院风湿免疫科住院并符合纳入标准和剔除排除标准的RA患者共501例。根据RF和CCP阳性与否分为(1)RF-、CCP-组,(2)RF+、CCP+组,(3)RF+、CCP-组,(4)RF-、CCP+组。并根据RF滴度分为RF高滴度阳性、RF低滴度阳性及RF阴性组。收集患者的一般资料:性别、年龄、病程;临床表现:晨僵时间、全身表现(发热、乏力、消瘦等)、关节肿胀数、关节压痛数、关节活动受限数、关节畸形数;实验室指标:血常规{白细胞(WBC)、血红蛋白(HGB)、血小板(PLT)}、急性时相反应物{红细胞沉降率(ESR)、C-反应蛋白(CRP)}、免疫球蛋白(IgG、IgA、lgM)、补体(C3、C4)、CCP、RF;影像学检查:双手X线片、胸部CT。对各组指标进行分析,得出结论。结果1.501例RA患者中RF-、CCP-组患者共105例,占20.96%。2.RF-CCP-组、RF+CCP+组、RF+CCP-组、RF-CCP+组四组平均病程分别为:7.37±7.79月、10.11±7.88月*、10.98±9.51月*、9.62±7.71月,RF-、CCP-组较其余三组病程短(*P0.05)。3.RF-、CCP-组PLT、IgA、IgG、lgM平均水平分别为275.81±92.17*10~9/L、2.69±1.17g/L、13.84±3.81g/L、1.34±0.64g/L,RF+、CCP+组PLT、IgA、IgG、lgM平均水平分别为297.43±85.78*10~9/L、3.13±1.34g/L、14.66±3.67g/L、1.51±0.62g/L,RF-、CCP-组PLT、IgA、IgG、lgM水平均低于RF+、CCP+组(P0.05)。4.RF-、CCP-组患者双手X线分期Ⅰ期发生率少于其余三组(29.52%、63.57%、57.14%、55.56%),而Ⅲ期发生率明显较其余三组高(60.95%、23.71%、30.95%、30.16%),差异均有统计学意义(P0.05)。5.501例RA患者中有29.14%的患者出现肺部病变,其中RF-、CCP-组有肺部病变的患者占31.43%,与其余三组肺部病变发生率比较无差异性。6.RF高滴度阳性组ESR水平显著高于低滴度阳性组及RF阴性组,RF水平与ESR(r=0.205,P=0.000)、PLT(r=0.171,P=0.000)呈正相关关系。结论1.本研究调查的501例RA患者中RF与CCP全阴性的RA患者占20.96%,提示RF与CCP全阴性的RA患者并不少见;2.血清RF与CCP全阴性的RA患者亦可出现较为严重的骨质破坏。3.血清RF与CCP全阴性的RA患者较全阳性及单一阳性患者病程短,较全阳性患者病情轻。4.RF滴度水平与炎症指标呈正相关关系。
[Abstract]:Objective to analyze the clinical characteristics, laboratory indexes and imaging findings of patients with rheumatoid arthritis (RA) with serum rheumatoid factor (RF) and anti-cyclic citrullin-peptide antibody (CCP) negative, so as to improve the understanding of RA patients with RF and CCP negative. Methods A retrospective study was conducted on 501 RA patients who were admitted to the Department of Rheumatological Immunology in the General Hospital of Ningxia Medical University from June 2011 to June 2016 and met the criteria of inclusion and exclusion. According to whether RF and CCP were positive or not, they were divided into three groups: (1) RF-CCP- group, (2) RF CCP- group, (3) RF CCP- group, (4) RF-CCP- group. According to RF titer, it was divided into RF high titer positive group and RF low titer positive group and RF negative group. General data of patients were collected: sex, age, course of disease, clinical manifestations: morning stiffness time, systemic manifestations (fever, fatigue, wasting, etc.), number of joint swelling, number of joint tenderness, number of limited joint movement, number of joint deformities; Laboratory parameters: routine blood test {white blood cell (WBC), hemoglobin (HGB), platelet (PLT)}, acute phase reactant {erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)}, immunoglobulin (IgGG) IgA lgM, complement (C _ 3C _ 4) CCPRFs; Imaging examination: both hands X ray, chest CTRF. The indexes of each group were analyzed and the conclusion was drawn. Results among the 1.501 patients with RA, 105 were in RF-CCP- group. 鍗，

本文编号：2055852