本文選題：抗環(huán)瓜氨酸肽抗體 + 類風濕因子��； 參考：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：目的通過對血清類風濕因子(RF)與抗環(huán)瓜氨酸肽抗體(CCP)陰性的類風濕關節(jié)炎(RA)患者的臨床特點、實驗室指標及影像學檢查進行分析,提高對RF與CCP陰性的RA患者的認識。方法回顧性調(diào)查2011年6月-2016年6月于寧夏醫(yī)科大學總醫(yī)院風濕免疫科住院并符合納入標準和剔除排除標準的RA患者共501例。根據(jù)RF和CCP陽性與否分為(1)RF-、CCP-組,(2)RF+、CCP+組,(3)RF+、CCP-組,(4)RF-、CCP+組。并根據(jù)RF滴度分為RF高滴度陽性、RF低滴度陽性及RF陰性組。收集患者的一般資料:性別、年齡、病程;臨床表現(xiàn):晨僵時間、全身表現(xiàn)(發(fā)熱、乏力、消瘦等)、關節(jié)腫脹數(shù)、關節(jié)壓痛數(shù)、關節(jié)活動受限數(shù)、關節(jié)畸形數(shù);實驗室指標:血常規(guī){白細胞(WBC)、血紅蛋白(HGB)、血小板(PLT)}、急性時相反應物{紅細胞沉降率(ESR)、C-反應蛋白(CRP)}、免疫球蛋白(IgG、IgA、lgM)、補體(C3、C4)、CCP、RF;影像學檢查:雙手X線片、胸部CT。對各組指標進行分析,得出結(jié)論。結(jié)果1.501例RA患者中RF-、CCP-組患者共105例,占20.96%。2.RF-CCP-組、RF+CCP+組、RF+CCP-組、RF-CCP+組四組平均病程分別為:7.37±7.79月、10.11±7.88月*、10.98±9.51月*、9.62±7.71月,RF-、CCP-組較其余三組病程短(*P0.05)。3.RF-、CCP-組PLT、IgA、IgG、lgM平均水平分別為275.81±92.17*10~9/L、2.69±1.17g/L、13.84±3.81g/L、1.34±0.64g/L,RF+、CCP+組PLT、IgA、IgG、lgM平均水平分別為297.43±85.78*10~9/L、3.13±1.34g/L、14.66±3.67g/L、1.51±0.62g/L,RF-、CCP-組PLT、IgA、IgG、lgM水平均低于RF+、CCP+組(P0.05)。4.RF-、CCP-組患者雙手X線分期Ⅰ期發(fā)生率少于其余三組(29.52%、63.57%、57.14%、55.56%),而Ⅲ期發(fā)生率明顯較其余三組高(60.95%、23.71%、30.95%、30.16%),差異均有統(tǒng)計學意義(P0.05)。5.501例RA患者中有29.14%的患者出現(xiàn)肺部病變,其中RF-、CCP-組有肺部病變的患者占31.43%,與其余三組肺部病變發(fā)生率比較無差異性。6.RF高滴度陽性組ESR水平顯著高于低滴度陽性組及RF陰性組,RF水平與ESR(r=0.205,P=0.000)、PLT(r=0.171,P=0.000)呈正相關關系。結(jié)論1.本研究調(diào)查的501例RA患者中RF與CCP全陰性的RA患者占20.96%,提示RF與CCP全陰性的RA患者并不少見;2.血清RF與CCP全陰性的RA患者亦可出現(xiàn)較為嚴重的骨質(zhì)破壞。3.血清RF與CCP全陰性的RA患者較全陽性及單一陽性患者病程短,較全陽性患者病情輕。4.RF滴度水平與炎癥指標呈正相關關系。
[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，

本文編號：2055852