抗环瓜氨酸多肽抗体阴性类风湿关节炎的临床特点分析

Analysis of clinical characteristics of anti-cyclic citrullinated peptide antibody negative rheumatoid arthritis

目的分析抗CCP抗体阴性RA患者的临床特点。方法回顾性分析2013年1月至2018年12月于北京大学第三医院风湿免疫科病房住院的RA患者的病历资料,收集患者的一般情况,关节表现,关节外表现以及实验室检查结果,使用U检验和χ^(2)检验比较抗CCP抗体阴性与抗CCP抗体阳性RA患者临床特点的差异。结果研究共纳入486例RA患者,其中抗CCP抗体阴性患者153例(31.5%),抗CCP抗体阳性患者333例(68.5%)。2组患者均表现为对称性多关节受累,与抗CCP抗体阳性RA患者相比,抗CCP抗体阴性RA患者病程更短(U=-4.750,P<0.01),出现晨僵时间≥1 h、肩肘关节受累、手关节炎的患者比例更少(P均<0.05),而下肢静脉血栓(χ^(2)=4.100,P=0.043)的发生率更高,血小板(U=-2.179,P=0.029)和CRP(U=-2.154,P=0.03)水平更高。根据RF进行亚组分析发现,抗CCP抗体阴性RF阳性组较抗CCP抗体阴性RF阴性组女性比例更高(P=0.042),肺间质病变(χ^(2)=5.652,P=0.017)和继发性SS(χ^(2)=11.211,P=0.001)发生率更高。结论抗CCP抗体阴性与抗CCP抗体阳性RA患者的关节表现特点相似,但抗CCP抗体阴性患者肩肘关节以及手关节受累更少见,而下肢静脉血栓的发生率更高,血小板和CRP水平更高,提示CCP-RA可能炎症反应更明显。

Objective To analyze the clinical characteristics of anti-cyclic citrullinated peptide(CCP)antibody-negative rheumatoid arthritis(RA)patients.Methods To retrospectively analyze the medical records of RA patients hospitalized in the department of rheumatology and immunity of Peking University Third Hospital from January 2013 to December 2018,we collected the baseline characteristics,joint manifestations,extra-articular manifestations,and laboratory parameters of RA patients,and compared the differences between anti-CCP antibody-negative patients and anti-CCP antibody-positive patients by U test and chi-square test.Results A total of 486 RA patients were included in this study,including 153 anti-CCP antibody-negative patients(31.5%)and 333 anti-CCP antibody-positive patients(68.5%).Compared with anti-CCP antibody-positive group,anti-CCP antibody-negative group had shorter disease course(U=-4.750,P<0.01)and the pro-portion of morning stiffness,shoulder or elbow joint involvement,and hand arthritis(P<0.05)was lower,while the incidence of phlebothrombosis of leg(χ^(2)=4.100,P=0.043)was higher,as well as thrombocytosis(U=-2.179,P=0.029)and elevation of CRP(U=-2.154,P=0.03).Subgroup analysis based on RF showed that CCP RF+group had higher percentage of women(P=0.042)and higher incidence of interstitial lung disease(χ^(2)=5.652,P=0.017)and secondary Sjögren's syndrome(χ^(2)=11.211,P=0.001),compared with CCP RF-group.Conclusion anti-CCP antibody-negative-patients have similar clinical char-acteristics with anti-CCP antibody-positive group,but the involvement of shoulder or elbow joint and hand arthritis are less common in anti-CCP antibody-negative group.Meanwhile the incidence of phlebothrombosis of leg is higher,and the level of platelet(PLT)and C-reactive protein(CRP)is higher,suggesting that anti-CCP antibody-negative RA may have more vident inflammatory response.