类风湿性关节炎患者眼表损害临床分析

Ocular surface lesions and relative antibodies in rheumatoid arthritis

目的 探讨女性类风湿性关节炎 (rheum atoid arthritis,RA )患者的眼表损害的临床特点。方法 对6 4例女性类风湿性关节炎患者分别进行眼表检查及相关血清学检查。结果 其眼表损害为干燥性结角膜炎 (kera-toconjunctivitis sicca,KCS) 18.8% (12 / 6 4 )、浅层巩膜炎 3.1% (2 / 6 4 )、硬化性角膜炎 1.6 % (1/ 6 4 )。 RF- Ig M(+)的RA患者中合并 KCS的发生率高于 RF- Ig M(- )的 RA患者合并 KCS的发生率为 2 5 .6 % (11/ 4 3) vs4 .8% (1/ 2 1)(P <0 .0 5 )。 C反应蛋白 (C Reactive Protein,CRP) >10 mg/ l,血沉 (Erythrocyte Sedim entation Rate,ESR) >30 mm / h在 12例 RA合并 KCS患者中的阳性率明显高于 5 2例 RA无合并 KCS患者中的阳性率 ,分别为 83.3%(10 / 12 ) vs5 1.9% (2 7.5 2 ) (P <0 .0 5 ) ;83.3% (10 / 12 ) vs6 9.2 % (36 / 5 2 ) (P <0 .0 5 ) ,而抗 SSA抗体阳性率则无明显差异 ,为 33.3% (4 / 12 ) vs9.6 % (5 / 5 2 ) (P >0 .0 5 )。抗 SSA抗体阳性率在 RA继发干燥综合征 (sjogren syn-drom e,SS)患者与 RA无继发 SS患者中无明显差异 ,为 14 .3% (2 / 7) vs12 .3(7/ 5 7) (P >0 .0 5 )。 2例合并浅层巩膜炎 ,其中 1例合并硬化性角膜炎 ,均有关节外损害。结论 女性类风湿性关节?

Objective To investigate the clinical features of the ocular surface lesions in female rheumatoid Arthritis.Methods Analyse the clinical date of 64 female cases of RA in their ocular surface lesions and antibodies.Results The incidences of ocular surface lesion in the female RA cases in our study are keratoconjunctivitis sicca (KCS) 18.8%(12/64),episclerotitis 3.1%(2/64),sclerosed keratitis 1.6%(1/64).The incidence of kcs in RF-IgM(+) RA patients is much higher than that in RF-IgM(-) RA patients,25.6%(11/43)vs 4.8%(1/21)(P<0.05).The incidences of C Reactive Protein (CRP)>10mg/l,Erythrocyte Sedimentation rate (ESR)>39mm/h in 12 cases of RA complicated with KCS are much higher than that in 52 cases of RA without KCS,they are 83.3%(10/12)vs51.9%(27/52)(P<0.05);83.3%(10/12)vs69.2%(36/52)(P<0.05) respectively,but at the same saturation the postitive rates of antiSSA are equalize as 33.3%(4/12)vs 9.6%(5/52)(P>0.05).Positive rate of antiSSA in 7 cases of SLE secondary sjogren's syndrom (ss)is equalize with positive rate of antiSSA in 57 cases of SLE nonsecondary ss,14.3%(2/7)vs12.3%(7/57)(P>0.05).2 cases of RA complicate with episclerotitis have serious out-joint lesions,one of them has sclerosed keratitis in addition.Conclusion The main ocular surface lesions in the female RA cases in our study are keratoconjunctivitis sicca(KCS),episclerotitis,sclerosed keratitis.RF-IgM(+) RA patients complicate with KCS frequently.RA complicate with KCS patients often appear CRP>10mg/l,ESR>30mm/h.KCS can be one of RA active norm.SSA-antibody can not be one of the assistant diagnositc criterion in RA complicated with KCS and secondary SS.Episclerotitis can be one of RA severe norm.