不同亚型银屑病关节炎的临床特征和实验室指标

Clinical Characteristics and Laboratory Parameters of Different Subtypes Psoriatic Arthritis

目的分析不同亚型银屑病关节炎(PsA)临床特征、实验室指标的差异,以提高对该疾病的认识,为临床诊疗提供借鉴。方法对中国人民解放军264医院2005年1月至2011年12月住院诊治的PsA患者进行分型,并对不同亚型PsA患者首发症状、受累关节、类风湿因子(RF)、抗环瓜氨酸多肽抗体(抗CCP抗体)、人类白细胞抗原-B27(HLA-B27)进行比较分析。结果 82例PsA患者,皮疹先发于关节炎者60例(73%),皮疹和关节炎症状1个月内同时出现者9例(11%),关节炎先发于皮疹者13例(16%)。PsA临床分型:远端指(趾)间关节炎型10例(12.2%)、残毁型关节炎型6例(7.3%)、对称性多关节炎型19例(23.2%)、非对称性寡关节炎型20例(24.4%)、脊柱关节炎型27例(32.9%)。红细胞沉降率、C反应蛋白在PsA各亚型之间比较,差异无统计学意义(均P>0.05)。对称性多关节炎型RF或抗CCP抗体的阳性率为68%,远高于脊柱关节炎型(P<0.05)。脊柱关节炎型HLA-B27阳性率为37%,远高于远端指(趾)关节炎型、对称性多关节炎型、非对称性寡关节炎型(均P<0.05)。结论 PsA多以皮疹为首发,仍有部分患者以关节炎首发。临床分型以脊柱关节炎型多见。RF阳性或抗CCP抗体阳性PsA患者易出现对称性多关节受累,HLA-B27阳性PsA患者易出现中轴关节受累。

Objective To better understand the psoriatic arthritis and provide reference for clinical diagnosis, by analyzing the differences of clinical characteristics and laboratory parameters among different subtypes of psoriatic arthritis （PsA）. Methods Classify the PsA patients treated in the 264th Hospital of the Chinese PLA fi＇om January 2005 to December 2011 into different subtypes by Wright and Moll＇ s PsA Classification and diagnostic criteria. Comparing the differences of first signs, involved joints, rheumatoid factor （RF） , anti-cyclic citrullinated peptides （anti CCP）, and human leukocyte antigen-B27 （HLA-B27） in the different subtypes. Results Among 82 cases with PsA, skin rashes appeared prior to arthritis occurred in 60 cases （73%）, the both symptoms appeared in the same month occurred in 9 cases （11%）, and in 13 cases （16%）, arthritis occurred prior to skin rashes. According to the joint manifestations, PsA was divided into 5 types ： （ 1 ） The type of distal interphalangeal joint （ only DIP/PIP involvement） occurred in 10 cases （12.2%） ; （2） The type of destroyed arthritis occurred in 6 cases （7.3%） ; （3） The type of symmetric polyarthritis occurred in 19 patients （23.2%）; （4） The type of asymmetric minority arthritis occurred in 20 eases （24.4%） ; （5） The type of Spinal arthritis occurred in 27 eases （32.9%）. The level of ESR and CRP was not signifieantly different in PsA subtypes （ all P 〉 0. 05 ）. Positive rate of RF or anti- CCP antibody in symmetric polyarthritis type was 68% , that was far higher than in the spinal arthritis type, and the differences were statistically significant （ P 〈 0.05 ）. Positive rate of HLA-B27 in spinal arthritis type was 37%, that was higher than in the type of distal interphalangeal joint, the symmetric polyarthritis type and asymmetric minority arthritis type, and the differences were statistically significant （ all P 〈 0. 05 ） Conclusions Skin rash is the common initial sign of PsA. The type of spinal arthritis is more often being seen in elinical subtypes of PsA. PsA patients with RF positive or anti-CCP antibody positive appear symmetrie polyarthritis easily. The result of HLA-B27 positivity is helpful in elinieal classification of psoriatic arthritis.