类风湿关节炎相关自身抗体与并发间质性肺病的相关性研究

Study on the association between rheumatoid arthritis autoantibodies and interstitial lung disease

目的探讨类风湿关节炎(RA)患者血清中自身抗体与RA并发间质性肺病(ILD)的潜在相关性。方法选取2015年1月-2018年12月在蚌埠医学院第一附属医院风湿免疫科住院治疗的856例RA患者,其中RA继发干燥综合征(SS)患者152例,RA并发ILD患者177例。所有RA患者根据有无ILD进行分组,分析RA患者并发ILD的影响因素。定量检测患者血清中的抗环瓜氨酸肽抗体(anti-CCP2)和类风湿因子(RF),定性检测anti-SSA/Ro52、anti-SSA/Ro60以及anti-SSB抗体,分析这些自身抗体与RA患者并发ILD的相关性。结果ILD在RA与RA继发SS两组间的发病率分别为19.89%、24.34%,组间ILD发病率比较差异无统计学意义(χ^2=1.511,P=0.219)。相较于无ILD的RA患者,伴有ILD的RA患者年龄更大、病程更长、anti-CCP2抗体水平以及RF滴度更高,2组间比较差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,RA患者是否继发SS、年龄、病程以及anti-CCP2抗体与ILD的发病相关(均P<0.05)。结论RA患者血清中anti-CCP2抗体阳性与并发ILD有关,RA继发SS患者血清中anti-SSA/Ro60、anti-SSA/Ro52和anti-SSB抗体与ILD发病无关。

Objective To explore the potential association between serum autoantibodies in patients with rheumatoid arthritis(RA)and RA complicated with interstitial lung disease(ILD).Methods Total 856 RA patients hospitalized in the Rheumatology and Immunology Department of the First Affiliated Hospital of Bengbu Medical College from 2015 to 2018 were retrospectively analyzed,152 patients with secondary Sjogren’s syndrome(SS)of whom were divided into another group for observation.Anti cyclic citrullinated peptide antibody(anti-CCP2)and rheumatoid factor(RF)in patients’serum were quantitatively detected.Anti-SSA/Ro52,anti-SSA/Ro60 and anti-SSB antibodies were qualitatively detected to evaluate the potential risks of these autoantibodies and ILD complicated by RA patients.Results The incidence of ILD in RA and RA secondary SS was 19.89%and 24.34%,respectively.There was no significant difference in the incidence of ILD between the groups(χ^2=1.511,P=0.219).Compared with RA patients without ILD,RA patients with ILD were older,had a longer course of disease,higher anti-CCP2 antibody levels,and higher RF titers,and The differences between the two groups were statistically significant(all P<0.05).Binary logistic regression analysis of age,course of disease,and risk of multiple autoantibodies and ILD in all RA patients showed that whether RA patients had secondary SS,age,course of disease,and anti-CCP2 antibodies were significantly related to the incidence of ILD(all P<0.05).Conclusion Anti-CCP2 positive in serum of RA patients is associated with concurrent ILD.Anti-SSA/Ro60,anti-SSA/Ro52 and anti-SSB antibodies in serum of RA patients with secondary SS are not related to the onset of ILD.