肾虚型类风湿关节炎卵巢储备功能下降的风险研究

发布时间：2018-08-23 18:43

【摘要】：目的：探讨肾虚型类风湿关节炎自身免疫失调状态及其出现卵巢储备功能下降的风险。方法：本研究纳入类风湿关节炎(rheumatoid arthritis, RA)患者320例,分为肾虚与非肾虚组,统计分析两组间性别、发病年龄、病程、类风湿因子(rheumatoid factor,RF)以及抗环瓜氨酸肽抗体(抗CCP抗体)的差异。同时,收集肾虚组中18-40岁未使用雷公藤制剂的女性患者37例作为病例组,健康志愿女性30例作为对照组,抽取外周血,检测血清抗苗勒管激素(anti-Mullerian hormone, AMH)水平,统计两组的年龄以及AMH水平,分析两组间出现AMH水平下降的差异以及出现AMH下降与年龄、病程、肿胀关节数、压痛关节数、红细胞沉降率(ESR)、C-反应蛋白(CRP)、DAS28评分、免疫球蛋白IgG、免疫球蛋白IgM的相关性。结果：1、本研究纳入肾虚型RA组159例,非肾虚型RA组161例。两组性别构成比较,P0.05,差异无统计学意义。2、肾虚型RA组的平均病程为129.08±129.48月,明显高于非肾虚型RA组(95.31±74.91月),两组比较,P=0.0050.05,差异有统计学意义。3、肾虚型RA组的平均发病年龄为50.96±13.21岁,明显高于非肾虚型RA组(40.63±13.21岁),两组比较,P=0.0000.05,差异有统计学意义。4、肾虚型RA组的平均RF滴度为685.89±1215.49IU/mL,明显高于非肾虚型RA组(524.09±835.39 IU/mL),两组比较,P=0.1660.05,差异无统计学意义。肾虚型RA组的平均抗CCP抗体滴度为127.50±80.46U/mL,明显高于非肾虚型RA组(107.38±82.37U/mL),两组比较,P=0.0390.05,差异有统计学意义。肾虚型RA组出现自身抗体双阳性(RF、抗CCP抗体均阳性)的风险是非肾虚型RA组的3.29倍,95%置信区间为[1.03-10.49],P=0.04,差异有统计学意义。5、本研究纳入病例组37例,健康对照组30例。病例组中平均年龄为31.78±6.10岁,AMH平均水平为2.87±4.98mg/L;健康对照组中平均年龄为25.70±3.51岁,AMH平均水平为2.86±3.66 mg/L。病例组出现AMH水平下降的风险是健康对照组的19.773倍,95%置信区间为[2.424-161.261],P=0.000,差异有统计学意义。6、病例组中出现AMH下降的风险与其病情活动情况(肿胀关节数、压痛关节数、ESR、CRP、DAS28评分)以及免疫功能指标(IgG、IgM)的相关性比较,P0.05,差异无统计学意义。结论：1、肾虚可能会加重类风湿关节炎的免疫失调状态,导致自身抗体增加。2、肾虚可能是类风湿关节炎出现卵巢储备功能下降的风险因素之一。
[Abstract]:Objective: to investigate the state of autoimmune disorder and the risk of ovarian reserve decline in rheumatoid arthritis of kidney deficiency type. Methods: 320 patients with rheumatoid arthritis (rheumatoid arthritis, RA) were divided into two groups: kidney deficiency group and non-kidney deficiency group. The differences of sex, age, course of disease, rheumatoid factor (rheumatoid factor,RF) and anti-cyclic citrullin-peptide antibody (anti-CCP antibody) between the two groups were statistically analyzed. At the same time, 37 female patients aged 18-40 years without Tripterygium wilfordii preparation were collected as case group and 30 healthy volunteers as control group. Peripheral blood samples were collected to detect the level of anti-mullerian hormone (anti-Mullerian hormone, AMH) in serum. The age and AMH levels of the two groups were analyzed, and the difference of AMH level between the two groups was analyzed. The decrease of AMH and age, the course of disease, the number of swollen joints, the number of tenderness joints, the (ESR) sedimentation rate of (ESR) and (CRP) / DAS28 score were analyzed. Correlation of immunoglobulin IgG, immunoglobulin IgM. Results: one, this study included 159 cases of kidney deficiency type RA group and 161 cases of non-kidney deficiency type RA group. The average course of disease in RA group was 129.08 卤129.48 months, which was significantly higher than that in non-kidney deficiency type RA group (95.31 卤74.91 months). The difference between two groups was statistically significant (P < 0.05). The average onset age of kidney deficiency type RA group was 50.96 卤13.21 years old. It was significantly higher than that of non-kidney deficiency type RA group (40.63 卤13.21 years old). The difference between the two groups was statistically significant. The average RF titer of the kidney deficiency type RA group was 685.89 卤1215.49 RF / mL, which was significantly higher than that of the non-kidney deficiency type RA group (524.09 卤835.39 IU/mL). There was no significant difference between the two groups (P 0.1660.05). The average titer of anti CCP antibody in RA group was 127.50 卤80.46 U / mL, which was significantly higher than that in non-kidney deficiency RA group (107.38 卤82.37U/mL), and the difference was statistically significant. The risk of autoantibody double positive (RF, anti CCP antibody positive) in RA group of kidney deficiency type was 3.29 times 95% confidence interval of 3. 29 times and 95% confidence interval of non kidney deficiency type RA group, the difference was statistically significant. There were 37 cases in this study group and 30 cases in healthy control group. The mean age was 31.78 卤6.10 years old and the mean age was 2.87 卤4.98 mg / L in the case group and the average age of 25.70 卤3.51 years old in the healthy control group was 2.86 卤3.66 mg/L.. The risk of AMH decrease in case group was 19.773 times 95% confidence interval of healthy control group (2.424-161.261), the difference was statistically significant. There was no significant difference in the correlation between the number of tenderness joints and the score of CRP DAS28 and the immune function index (IgG,IgM) (P 0.05). Conclusion: 1, the deficiency of kidney may aggravate the immune disorder of rheumatoid arthritis, and lead to the increase of autoantibodies. The deficiency of kidney may be one of the risk factors for the decline of ovarian reserve function in rheumatoid arthritis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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