类风湿关节炎患者血清SAA、抗CCP抗体与中医辨证分型的关系

Relationship between Serum SAA,Anti-CCP Antibody and TCM Syndrome Differentiation in Patients with Rheumatoid Arthritis

目的探讨类风湿关节炎(RA)患者血清淀粉样蛋白A(SAA)、抗环瓜氨酸肽(CCP)抗体与中医辨证分型的关系。方法选取2020年5月—2021年4月医院门诊收治的128例RA患者,另选取健康自愿者30例为对照组,采用酶联免疫法测定受试者血清SAA、抗CCP抗体水平,分析中医辨证分型血清SAA、抗CCP抗体的差异。结果128例RA患者中湿热痹阻证53例(41.41%)、痰瘀痹阻证29例(22.65%)、寒湿痹阻证24例(18.75%)、肝肾亏虚证22例(17.19%),湿热痹阻证组、痰瘀痹阻证组、寒湿痹阻证组、肝肾亏虚证组患者的28处关节疾病活动性评估(DAS28)评分依次降低,且组间差异有统计学意义(P<0.001);RA各证型组活动期与缓解期的血清SAA、抗CCP抗体均明显高于对照组(P<0.05),活动期湿热痹阻证组血清SAA、抗CCP抗体明显高于其他证型(P<0.05),活动期寒湿痹阻证组血清SAA、抗CCP抗体高于痰瘀痹阻证组、肝肾亏虚证(P<0.05),而痰瘀痹阻证组、肝肾亏虚证活动期血清SAA、抗CCP抗体差异无统计学意义(P>0.05),各证型缓解期血清SAA、抗CCP抗体的差异无统计学意义(P>0.05);湿热痹阻证组血清SAA、抗CCP抗体阳性率明显高于痰瘀痹阻证组、寒湿痹阻证组及肝肾亏虚证组,差异有统计学意义(P<0.05),其他各组血清SAA、抗CCP抗体阳性率差异无统计学意义(P>0.05)。结论血清SAA、抗CCP抗体与RA中医辨证分型存在一定联系,二者可做为湿热痹阻证、寒湿痹阻证的辨证的客观指标。

Objective To explore the relationship between serum amyloid A(SAA),anti-cyclic citrullinated peptide(CCP)antibody and TCM syndrome differentiation in patients with rheumatoid arthritis(RA).Methods From May 2020 to April 2021,128 patients with RA admitted in the hospital outpatient clinic were selected.Another 30 healthy volunteers were selected as the control group.The serum levels of SAA and anti-CCP antibody of the subjects were determined by enzyme-linked immunosorbent assay.The difference of serum SAA and anti-CCP antibody according to syndrome differentiation was analyzed.Results Among 128 RA patients,53 cases(41.41%)were damp-heat blocking syndrome,29 cases(22.65%)were phlegm and blood stasis blocking syndrome,24 cases(18.75%)were cold-dampness blocking syndrome,and 22 cases(17.19%)were liver-kidney deficiency syndrome.The DAS28 scores of patients in the damp-heat blocking syndrome group,phlegm and blood stasis blocking syndrome syndrome group,cold-dampness blocking syndrome group and liver-kidney deficiency syndrome group were decreased successively,and the difference among the groups was statistically significant(P<0.001).The serum SAA and anti-CCP antibodies in the active and remission stages of the RA syndrome groups were significantly higher than those in the control group(P<0.05),and the serum SAA and anti-CCP antibody in the damp-heat blocking syndrome group during the active stage were significantly higher than those of the other syndrome types(P<0.05),the serum SAA and anti-CCP antibody in cold-dampness blocking syndrome group during the active period were higher than those in phlegm and blood stasis blocking syndrome group and liver and kidney deficiency syndrome group(P<0.05).However,there was no statistically significant difference in serum SAA or anti-CCP antibodies between the phlegm and blood stasis blocking syndrome group and liver-kidney deficiency syndrome in the active phase(P>0.05).There was no statistically significant difference in serum SAA or anti-CCP antibodies in the remission phase of each syndrome group(P>0.05).The positive rates of serum SAA and anti-CCP antibody in the damp-heat blocking syndrome group were significantly higher than those of the phlegm and blood stasis blocking syndrome group,cold-dampness blocking syndrome group,and liver-kidney deficiency syndrome group.The difference was statistically significant(P<0.05).There was no significant difference in the positive rates of serum SAA or anti-CCP antibodies among other groups(P>0.05).Conclusion There is a certain connection between serum SAA and anti-CCP antibodies and TCM syndrome differentiation of RA,and the two can be regarded as the objective index of the syndrome differentiation of damp-heat blocking syndrome and cold-dampness blocking syndrome.