类风湿关节炎合并甲状腺过氧化物酶抗体阳性患者的临床特征和危险因素分析

Clinical characteristics and risk factors of patients with rheumatoid arthritis and positive thyroid peroxidase antibody

目的探讨类风湿关节炎(RA)合并甲状腺过氧化物酶抗体(TPOAb)阳性患者的临床特点并分析TPOAb阳性的危险因素。方法选取191例RA患者作为研究对象,根据TPOAb水平分为TPOAb阴性组(TPOAb≤34 IU/mL)和TPOAb阳性组(TPOAb>34 IU/mL),比较2组患者的临床资料、实验室指标及免疫学指标水平,并采用多因素Logistic回归分析确定TPOAb阳性的危险因素。结果TPOAb阳性组年龄、白细胞介素-10(IL-10)水平低于TPOAb阴性组,肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)水平高于TPOAb阴性组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高IL-17(OR=1.395,95%CI为1.005~1.937,P=0.047)、高TNF-α(OR=1.051,95%CI为1.013~1.090,P=0.008)、低IL-10(OR=0.795,95%CI为0.652~0.968,P=0.022)是TPOAb阳性的独立危险因素。结论RA患者的TPOAb阳性率达14.7%(与年龄有关),高TNF-α、高IL-17、低IL-10水平是TPOAb阳性的危险因素。

Objective To investigate clinical characteristics of patients with rheumatoid arthritis(RA)and positive thyroid peroxidase antibody(TPOAb),and to analyze the risk factors affecting the level of TPOAb.Methods A total of 191 RA patients were selected as study objects and were divided into TPOAb negative group(TPOAb≤34 IU/mL)and TPOAb positive group(TPOAb>34 IU/mL).The differences of clinical data,laboratory indexes and immunological indexes between the two groups were compared,and the risk factors of TPOAb level were determined by multivariate Logistic regression analysis.Results Age and interleukin-10(IL-10)in the TPOAb positive group were lower than those in the TPOAb negative group(P<0.05),the level of interleukin-17(IL-17)and tumor necrosis factor-α(TNF-α)in the TPOAb positive group were higher than those in the TPOAb negative group(P<0.05).Multivariate Logistic regression analysis showed the higher level of IL-17(OR=1.395,95%CI,1.005 to 1.937,P=0.047)and higher level of TNF-α(OR=1.051,95%CI,1.013 to 1.090,P=0.008)and lower level of IL-10(OR=0.795,95%CI,0.652 to 0.968,P=0.022)were independent influencing factors for positive TPOAb.Conclusion In RA patients,the positive rate of TPOAb is 14.7%(correlated with to age).High levels of IL-17 and TNF-αand low level of IL-10 are high risk factors of TPOAb.