类风湿关节炎患者甲襞微循环及血液流变学改变的临床研究

Clinical study of nailfold microcirculation and hemorheology changes in patients with rheumatoid arthritis

目的探索类风湿关节炎(rheumatoid arthritis,RA)患者甲襞微循环与临床特征、自身抗体以及血液流变学的相关性。方法选取2021年1月~2022年2月就诊于哈尔滨医科大学附属第二医院风湿免疫科的类风湿关节炎患者31例。根据是否合并肺间质病变(interstitial lung disease,ILD)将患者分为ILD组(n=11)和无ILD组(n=18);根据抗核抗体(anti-nuclear antibody,ANA)将患者分为ANA阳性组(n=9)和ANA阴性组(n=22);根据类风湿因子(rheumatoid factor,RF)将患者分为RF阳性组(n=29)和RF阴性组(n=2);根据抗环瓜氨酸抗体(anti-cyclic citrullinated peptide antibody,抗CCP抗体)将患者分为CCP阳性组(n=11)和CCP阴性组(n=17);根据受累关节将患者分为手关节受累组(n=20)和无手关节受累组(n=11);根据是否伴晨僵将患者分为晨僵组(n=22)和不伴晨僵组(n=9)。分析甲襞微循环与性别、病程、ILD、手关节受累、ANA阳性、抗CCP抗体、RF、C反应蛋白(C-reactive protein,CRP)、血小板计数(platelet count,PLT)以及血液流变学的相关性。结果缓解期组RA患者的甲襞微循环形态积分明显低于低疾病活动度组(P=0.048),总积分明显低于中高疾病活动度组(P=0.044)。不同病程RA患者甲襞微循环积分与血液流变学均有不同程度的改变,甲襞微循环总积分与刚性指数最具相关性(P=0.04)。结论病程、疾病活动度对RA患者甲襞微循环及血液流变学均存在明显影响,同时抗核抗体阳性及肺间质病变会影响RA患者的甲襞微循环。

Objective To explore the correlation between nailfold microcirculation and clinical characteristics,autoantibodies and hemorheology in patients with rheumatoid arthritis(RA).Methods A total of 31 patients with RA who were admitted to the Department of Rheumatology and Immunology of the Second Affiliated Hospital of Harbin Medical University from January 2021 to February 2022 were selected.According to whether they had interstitial lung disease(ILD),the patients were divided into ILD group(n=11)and non-ILD group(n=18).According to anti-nuclear antibody(ANA),the patients were divided into ANA positive group(n=9)and ANA negative group(n=22).According to rheumatoid factor(RF),patients were divided into RF positive group(n=29)and RF negative group(n=2).According to anti-cyclic citrullinated peptide antibody(CCP),the patients were divided into CCP positive group(n=11)and CCP negative group(n=17).According to the affected joints,patients were divided into hand joint involved group(n=20)and no hand joint involved group(n=11).According to whether they were accompanied by morning stiffness,patients were divided into morning stiffness group(n=22)and without morning stiffness group(n=9).The correlation of nailfold microcirculation with sex,course of disease,ILD,hand joint involvement,ANA positive,anti-cyclic citrullinated peptide antibody(anti-CCP antibody),rheumatoid factor(RF),C-reactive protein(CRP),platelet count(PLT)and hemorheology was analyzed.Results The morphological score of nailfold microcirculation in RA patients in remission stage was significantly lower than that in low disease activity group(P=0.048),and the total score of nailfold microcirculation in RA patients in remission stage was significantly lower than that in moderate and high disease activity group(P=0.048).The nailfold microcirculation score and hemorheology of RA patients with different course of disease had different degrees of change,and the total score of nailfold microcirculation was colosely correlated with the rigidity index(P=0.04).Conclusion Disease duration and disease activity have significant effects on nailfold microcirculation and hemorheology in RA patients,and positive antinuclear antibody and interstitial lung disease may affect nailfold microcirculation in RA patients.