血清抗环瓜氨酸肽抗体阳性与阴性类风湿关节炎患者的临床特点比较

Comparisons of clinical characteristics between anti-cyclic citrullinated peptide antibody positive and negative patients with rheumatoid arthritis

目的:探讨血清抗环瓜氨酸肽(ACCP)抗体阳性与阴性类风湿关节炎(RA)患者临床表现及预后的差异,为临床诊疗提供参考。方法:根据血清ACCP抗体将116例类风湿关节炎患者分为两组,ACCP抗体阳性组75例,阴性组41例。分析ACCP抗体阳性组与阴性组的临床表现及相关实验室检查结果,比较两组间的差异。结果:ACCP抗体阳性组患者有发热、乏力等全身症状者较ACCP抗体阴性组多且严重(P<0.05)。血沉、C反应蛋白亦以ACCP抗体阳性组显著为高(P<0.05或<0.01)。ACCP抗体阳性组血红蛋白显著降低,而血小板计数显著增加,与ACCP抗体阴性组比较,差异均具有统计学意义(P<0.05)。RA病程达2年以上者,血清ACCP抗体阳性组双侧腕、肘、髋及膝关节X线片表现≥Ⅲ级以上者显著多于ACCP抗体阴性组(P<0.05)。病程小于2年且无明显骨质破坏的RA患者,1年后发生骨质破坏者,ACCP抗体阳性组明显多于阴性组,差异具有统计学意义(P<0.05)。结论:血清ACCP抗体阳性的RA患者较ACCP抗体阴性者临床症状重,血液系统、骨骼系统损害多见,预后差。血清ACCP抗体可能反映RA的临床症状轻重并判断预后。

Objective To investigate the significance of the anti-cyclic citrullinated peptide （ACCP） antibody in progression and prognosis of patients with rheumatoid arthritis （RA）. Methods 116 patients with RA were divided into ACCP positive group and negative group according to serum ACCP level, and the distinctions of clinical data and prognosis between the two groups were analyzed. Results The ACCP positive group tended to have more general symptoms including fever and languor, which appeared to be more serious than the negative group （P 〈 0.05）. The ACCP positive group showed significant difference in serum level of erythrocyte sedimentation rate and C-creative protein （P 〈 0.05 or 〈 0.01）. Hemoglobin decreased, while platelet raised significantly in ACCP positive group （P 〈 0.05）, compared with the negative group, respectively. Whether patients suffered RA for more than 2 years or not, the ACCP positive group showed more potential to develope bone erosion than the ACCP negative group （P 〈 0.05）. Conclusion Serum ACCP level may reflect disease severity of patients with RA and have good predictive value for RA.