关节痛型狼疮与类风湿关节炎实验室指标鉴别

Study on serologic clinical features of systemic lupus erythematosus joint pain and rheumatoid arthritis with joint pain

目的探究关节痛型系统性红斑狼疮与类风湿关节炎关节痛患者实验室检查指标的特点,为二者诊断和鉴别诊断提供依据。方法选取四川大学华西医院2018年1月-2019年1月期间收治关节痛型SLE患者214例,关节痛RA患者192例,分别对相关实验室检测指标CRP、ESR、ASO、免疫球蛋白、C3、C4、RF、PCT和抗CCP抗体以及ANA、AKA、ANCA、抗dsDNA抗体、抗SM抗体、抗SSA和抗SSB抗体进行比较分析。结果关节痛型SLE患者的多种自身抗体阳性率均高于关节痛RA患者,包括抗dsDNA抗体(48.41%vs.2.25%)、抗SM抗体(18.46%vs.1.96%)等,但C3(0.61vs.0.83)、C4(0.15vs.0.20)、CRP(10.72vs.31.25)、ESR(35.63vs.50.92)、RF(213.87vs.555.11)、IgM(0.87vs.1.39)含量显著低于RA组,并且AKA(5.71%vs.59.38%)阳性率也低于RA组(P<0.05)。结论自身抗体阳性及补体C3、C4降低是关节痛型SLE患者的实验室特点,而血清CRP、ESR、IgM、RF及AKA显著升高是关节痛RA患者的实验室特征,对于两种疾病的诊断与鉴别诊断具有重要提示价值。

Objective To explore the clinical serological characteristics of systemic lupus erythematosus(SLE)patients with joint pain and rheumatoid arthritis(RA),and provide evidence for the clinical and differential diagnosis.Methods 214SLE joint pain patients and 192RA patients of West China Hospital of Sichuan University were included from January 2018to January 2019.All tests including CRP,ESR,ASO,immunoglobulin,C3,C4,RF,PCT,anti-CCP,ANA,AKA,ANCA,anti-dsDNA,anti-SM,anti-SSA and anti-SSB were analyzed.Results The positive rate of multiple autoantibodies in SLE patients with joint pain were higher than those of RA patients,including anti-dsDNA antibody(48.41%vs.2.25%),anti-SM antibody(18.46%vs.1.96%)and so on.But the content of C3(0.61vs.0.83),C4(0.15vs.0.20),CRP(10.72vs.31.25),ESR(35.63vs.50.92),RF(213.87vs.555.11),IgM(0.87vs.1.39)were significantly lower than those of RA group,and the positive rate of AKA(5.71%vs.59.38%)was also lower than the RA group.Conclusion Positive autoantibody and decreased complement C3and C4are the laboratory characteristics of SLE joint pain patients,while significantly increased serum CRP、ESR、IgM、RF and AKA are the laboratory characteristics of RA,which has important value for the diagnosis and differential diagnosis of the two diseases.