自身抗体与肾虚型类风湿关节炎的相关性研究

Correlation Study of Auto-immune Antibodies and Rheumatoid Arthritis Patients of Shen Deficiency Syndrome

目的探讨自身抗体与肾虚型类风湿关节炎(RA)之间的关系,为进一步研究肾虚型RA发生的分子生物学机制提供临床依据。方法将451例RA患者按中医辨证分为肾虚型组和非肾虚型组,比较两组一般情况,包括性别、年龄、病程、发病年龄、C反应蛋白(CRP)、血沉(ESR)、血小板(PLT),病情活动情况(DAS28),自身抗体包括类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、抗核抗体(ANA)。结果 (1)肾虚型组ESR、PLT、DAS28评分明显高于非肾虚型组(P<0.05,P<0.01);(2)肾虚型组与非肾虚型组RF分别为(697.32±1061.38)IU/mL和(439.91±672.24)IU/mL,两组比较,差异有统计学意义(P<0.01),抗CCP抗体两组比较,差异无统计学意义(P>0.05)。(3)RA患者ANA阳性率为29.63%(120/405)。肾虚型组ANA阳性率为37.19%(74/199),非肾虚型组为22.33%(46/206),两组比较,差异有统计学意义(P<0.01)。(4)肾虚型RA患者出现ANA阳性和RF高滴度阳性的风险分别是非肾虚型的2.059倍和1.574倍。结论肾虚RA出现自身抗体的风险更高、病情进展更快、关节破坏更严重、预后更差,相关机制可能与B细胞免疫失耐受密切相关。

Objective To investigate the correlation between anto-immune antibodies and rheumatoid arthritis （RA） patients of Shen deficiency syndrome （SDS）, thus providing clinical evidence for further researches on molecular biological mechanisms of RA patients of SDS. Methods Totally 451 RA patients were assigned to the SDS group and the non-SDS group. Their general conditions （including gender, age, duration, and age of onset）, C reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, platelet （PLT）, disease activities （DAS28）, auto-antibodies [rheumatoid factor （RF）, anti-CCP antibodies, anti-nuclear antibody （ANA）] were compared between the two groups. Results （1） The scores for EST, PLT, and DAS28 were obviously higher in the SDS group than in the non-SDS group （P 0.05, P 0.01）. （2） The level of average RF was （697.32±1 061.38 IU/mL） in the SDS group, higher than that in the non-SDS group （439.91±672.24 IU/mL, P 0.01）. There was no statistical difference in anti-CCP antibody between the two groups （P 0.05）.（3） The ANA positive rate of RA patients was 29.63% （120/405）. It was 37.19% （74/199） in RA patients of SDS and 22.33% （46/206） in RA patients of non-SDS, showing statistical difference between the two groups （P 0.01）.（4） The odds ratio for high level RF positive and ANA positive was 1.574 and 2.059 folds in RA patients of SDS as high as that in RA patients of non-SDS. Conclusions RA patients of SDS would have higher risk of having auto-immune antibodies, fastened development, more worsen joint damage, and more poor prognosis. Its mechanisms might be closely associated with autoimmune tolerance.