【摘要】：目的：探討腎虛型類風(fēng)濕關(guān)節(jié)炎自身免疫失調(diào)狀態(tài)及其出現(xiàn)卵巢儲備功能下降的風(fēng)險(xiǎn)。方法：本研究納入類風(fēng)濕關(guān)節(jié)炎(rheumatoid arthritis, RA)患者320例,分為腎虛與非腎虛組,統(tǒng)計(jì)分析兩組間性別、發(fā)病年齡、病程、類風(fēng)濕因子(rheumatoid factor,RF)以及抗環(huán)瓜氨酸肽抗體(抗CCP抗體)的差異。同時(shí),收集腎虛組中18-40歲未使用雷公藤制劑的女性患者37例作為病例組,健康志愿女性30例作為對照組,抽取外周血,檢測血清抗苗勒管激素(anti-Mullerian hormone, AMH)水平,統(tǒng)計(jì)兩組的年齡以及AMH水平,分析兩組間出現(xiàn)AMH水平下降的差異以及出現(xiàn)AMH下降與年齡、病程、腫脹關(guān)節(jié)數(shù)、壓痛關(guān)節(jié)數(shù)、紅細(xì)胞沉降率(ESR)、C-反應(yīng)蛋白(CRP)、DAS28評分、免疫球蛋白IgG、免疫球蛋白IgM的相關(guān)性。結(jié)果：1、本研究納入腎虛型RA組159例,非腎虛型RA組161例。兩組性別構(gòu)成比較,P0.05,差異無統(tǒng)計(jì)學(xué)意義。2、腎虛型RA組的平均病程為129.08±129.48月,明顯高于非腎虛型RA組(95.31±74.91月),兩組比較,P=0.0050.05,差異有統(tǒng)計(jì)學(xué)意義。3、腎虛型RA組的平均發(fā)病年齡為50.96±13.21歲,明顯高于非腎虛型RA組(40.63±13.21歲),兩組比較,P=0.0000.05,差異有統(tǒng)計(jì)學(xué)意義。4、腎虛型RA組的平均RF滴度為685.89±1215.49IU/mL,明顯高于非腎虛型RA組(524.09±835.39 IU/mL),兩組比較,P=0.1660.05,差異無統(tǒng)計(jì)學(xué)意義。腎虛型RA組的平均抗CCP抗體滴度為127.50±80.46U/mL,明顯高于非腎虛型RA組(107.38±82.37U/mL),兩組比較,P=0.0390.05,差異有統(tǒng)計(jì)學(xué)意義。腎虛型RA組出現(xiàn)自身抗體雙陽性(RF、抗CCP抗體均陽性)的風(fēng)險(xiǎn)是非腎虛型RA組的3.29倍,95%置信區(qū)間為[1.03-10.49],P=0.04,差異有統(tǒng)計(jì)學(xué)意義。5、本研究納入病例組37例,健康對照組30例。病例組中平均年齡為31.78±6.10歲,AMH平均水平為2.87±4.98mg/L;健康對照組中平均年齡為25.70±3.51歲,AMH平均水平為2.86±3.66 mg/L。病例組出現(xiàn)AMH水平下降的風(fēng)險(xiǎn)是健康對照組的19.773倍,95%置信區(qū)間為[2.424-161.261],P=0.000,差異有統(tǒng)計(jì)學(xué)意義。6、病例組中出現(xiàn)AMH下降的風(fēng)險(xiǎn)與其病情活動情況(腫脹關(guān)節(jié)數(shù)、壓痛關(guān)節(jié)數(shù)、ESR、CRP、DAS28評分)以及免疫功能指標(biāo)(IgG、IgM)的相關(guān)性比較,P0.05,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論：1、腎虛可能會加重類風(fēng)濕關(guān)節(jié)炎的免疫失調(diào)狀態(tài),導(dǎo)致自身抗體增加。2、腎虛可能是類風(fēng)濕關(guān)節(jié)炎出現(xiàn)卵巢儲備功能下降的風(fēng)險(xiǎn)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 鹵129.48 months, which was significantly higher than that in non-kidney deficiency type RA group (95.31 鹵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 鹵13.21 years old. It was significantly higher than that of non-kidney deficiency type RA group (40.63 鹵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 鹵1215.49 RF / mL, which was significantly higher than that of the non-kidney deficiency type RA group (524.09 鹵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 鹵80.46 U / mL, which was significantly higher than that in non-kidney deficiency RA group (107.38 鹵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 鹵6.10 years old and the mean age was 2.87 鹵4.98 mg / L in the case group and the average age of 25.70 鹵3.51 years old in the healthy control group was 2.86 鹵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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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