修订分类标准诊断血清学阴性与阳性类风湿关节炎临床特征的比较-东南大学学报医学版

修订分类标准诊断血清学阴性与阳性类风湿关节炎临床特征的比较

单位：桂林医学院附属医院风湿免疫科, 广西桂林 541001

分类号：R593.22

出版年·卷·期（页码）：2016·35·第五期（664-669）

摘要：

目的：探讨2010年ACR/EULAR修订的类风湿关节炎（RA）分类标准诊断的血清学阴性与阳性RA患者临床特征差异。方法：选取57例血清学阴性RA患者和240例血清学阳性RA患者，分析两组性别、起病年龄、病程、确诊时间、受累关节部位、关节数、DAS28评分及并发症情况，比较两组患者的治疗方案及疗效。结果：（1）血清学阴性组平均病程（47.58±26.43）个月，确诊时间（33.71±21.56）个月，血清阴性组女性患者占43%。（2）血清学阴性组总受累关节数（13.35±8.21）个，受累小关节数（9.94±6.30）个；其中膝关节占14.10%，肘关节18.73%，踝关节19.29%，掌指关节14.47%，近段指间关节15.21%，腕关节14.10%。（3）血清学阴性组出现肺间质病变占21.05%，肺动脉高压17.54%，心包积液5.3%。（4）血清学阴性组血红蛋白（Hb）质量浓度（108.28±16.94）g·L^-1，血小板计数（PLT）（284.87±91.51）×10⁹ L^-1，球蛋白（Glo）质量浓度（33.70±11.75）g·L^-1，C反应蛋白（CRP）质量浓度（38.06±40.75）mg·L^-1，红细胞沉降率（ESR）（58.63±38.76）mm·h^-1，DAS28评分（5.65±1.35）分。（5）血清学阴性组57例患者中使用糖皮质激素46例，抗骨质疏松药33例，植物药51例，治疗后Glo下降（10.84±9.56）g·L^-1，ESR下降（31.05±29.51）mm·h^-1，CRP下降（28.85±35.87）mg·L^-1，DAS28评分下降（1.79±1.00）分。结论：应用修订RA分类标准可对血清阴性患者进行早诊断。此类患者受累关节数及小关节少；关节外病变少；Hb水平高，PLT、Glo、CRP、ESR水平及DAS28评分低，对于强度较低的治疗方案效果好。

Objective: To compare the clinic, laboratory features, disease activity, the differences of treatment and effect of sero-nagative and sero-positive rheumatoid arthritis patients diagnosed by 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis. Method: 297 RA patients were included in this study and allocated into sero-nagetive group(n=57)and sero-positive group(n=240). The clinic, laboratory features, disease activity, the differences of treatment and effect were compared between the two groups. Results: (1) The course of disease in sero-negative group was (47.58±26.43) months, the time required to diagnosis (33.71±21.56) months. The percentage of female patients in sero-negative group was 43%. (2) The total number of affected joints were 13.35±8.21, the affected small joints were 9.94±6.30; the percent of affected knees were 14.10%, the elbows were 18.73% and the ankles were 19.29%; but the affected metacarpophalangeal joints were 14.47%, the proximal interphalangeal joints were 15.21% and the wrists were 14.10%. (3) The percentage of the patients occurring interstitial lung disease were 21.05%, pulmonary hypertension were 17.54%, pericardial effusion were 5.3% in the sero-negative group. (4) Hb levels of the the sero-negative group were (108.28±16.94)g·L^-1, PLT(284.87±91.51)×10⁹ L^-1, Glo(33.70±11.75)g·L^-1, CRP(38.06±40.75)mg·L^-1, ESR(58.63±38.76)mm·h^-1. (5) As for the treatment, 46 patients in the sero-negative group chose glucocorticoids, 33 patients chose anti-osteoporosis drugs and 51 patients chose herbals. After treatment, the Glo level was decreased by(10.84±9.56)g·L^-1, ESR decreased by(31.05±29.51)mm·h^-1, CRP decreased by(28.85±35.87)mg·L^-1 and DAS28 scores decreased by 1.79±1.00. Conclusion: Sero-negative RA patients can be diagnosed in the early course by 2010 ACR/EULAR classification criteria revision of RA. These patients are characterized by less involvements of joints and as well as less small joints, less complications, higher Hb levels and lower Glo, positive ESR and CRP levels and lower DAS28 scores. These patients can achieve better outcome than those in sero-positive group undergoing mild treatments.

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