邢雪^1,,
刘佳庆²,
冯鑫妍^3,,
1. 大连医科大学附属第二医院 检验科，辽宁 大连 116027
2. 大连医科大学 基础医学院 免疫学教研室，辽宁 大连 116044
3. 大连医科大学附属第二医院 肾内科，辽宁 大连 116027

详细信息 作者简介: 邢 雪（1988-），女，主管技师。E-mail：dyeyxx39198645@126.com



通讯作者: 冯鑫妍，主管技师。Email: 13390000376@163.com 中图分类号: R392


摘要:目的分析类风湿因子（rheumatoid factor，RF）阴性及不同滴度阳性的类风湿关节炎（rheumatoid arthritis，RA）患者的实验室及临床特征差异。方法研究共纳入从2019年1月至2020年5月于大连医科大学附属第二医院住院的RA患者123例，这些患者3个月内均未应用糖皮质激素及免疫抑制剂等可能影响本研究结果的药物。将患者分为RF阴性组、RF低滴度组（≤上限3倍）和RF高滴度组（＞上限3倍）。比较三组的一般资料、实验室指标（血液学、免疫学、血糖和血脂指标）、影像学资料（骨侵蚀或骨破坏）、部分临床合并症，包括间质性肺疾病（interstitial lung disease，ILD）、干燥综合征（sjogren syndrome，SS）、甲状腺疾病（甲状腺结节、甲状腺炎症等）。结果三组患者的年龄、性别、病程、DAS28评分、ESR及CRP差异均无统计学意义（P＞0.05）。三组患者外周血WBC水平有统计学差异（P=0.028），两两比较显示RF阴性组高于RF高滴度组 （P=0.012）。三组患者的C3水平、IgM水平及抗环瓜氨酸肽抗体（CCP）水平差异均有统计学意义（P=0.036，P=0.005，P＜0.001）。RF阴性组的C3水平高于RF低滴度组（P=0.007），RF高滴度组C3水平也高于低滴度组（P=0.019）；RF阴性组IgM水平低于高滴度组（P=0.002）。三组患者的血糖水平有明显差异（P=0.021），RF阴性组高于高滴度组（P=0.010）。RF阴性组APOB水平也明显高于高滴度组（P=0.029）。三组患者的骨侵蚀或骨破坏程度及合并ILD、SS及甲状腺疾病情况差异均无统计学意义（P＞0.05）。结论RF阴性的RA患者仍处于炎症高反应状态，应该及早关注实验室指标及影像学异常，早期预测心脑血管疾病和代谢综合征等危险因素，帮助早期诊断和精准化干预治疗。
关键词: 类风湿关节炎/
类风湿因子/
滴度/
实验室指标


Abstract:ObjectiveTo analyze the laboratory and clinical characteristics of patients with rheumatoid arthritis (RA) with different titers of rheumatoid factor (RF).MethodsA total of 123 RA patients, who were hospitalized in the Department of Rheumatology at Dalian Medical University Affiliated Hospital from January 2019 to May 2020, were included in the study. None of these patients were treated with glucocorticoids and immunosuppressants that may affect the results of this study in the last three months. According to different RF titers, the patients were divided into RF negative group, RF low titer group (≤ 3 times of the upper limit) and RF high titer group (＞3 times of the upper limit). The general data, laboratory indexes (hematology, immunology, blood glucose and blood lipid indexes), imaging data (bone erosion or bone destruction) and clinical complications [interstitial lung disease (ILD), sjogren syndrome (SS), thyroid disease (thyroid nodules, thyroid inflammation, etc)] were compared among the three groups.ResultsThere were no significant differences in age, sex, duration of disease, DAS28 score, ESR and CRP among the three groups (P＞0.05). The level of white blood cells (WBC) was significant different in the three groups (P=0.028). Comparison between each two groups indicated that the WBC in the RF negative group was higher than the RF high titer group (P=0.012). There were significant differences in the levels of C3 (P=0.036), immunoglobulin M (IgM) (P=0.005) and anticyclic citrullinated peptide antibody (CCP) (P＜0.001). The C3 level of RF negative group was higher than that of RF low titer group (P=0.007), the C3 level of RF high titer group was higher than that of RF low titer group (P=0.019), and the IgM level of RF negative group was lower than that of RF high titer group (P=0.002). The blood glucose (Glu) levels of the three groups were significantly different (P=0.021), the RF negative group was higher than the RF high titer group (P=0.010). Pairwise comparison revealed that APOB levels (P=0.029) were significantly increased in the negative group. There were no significant differences in the degree of bone erosion or bone destruction and the combined ILD, SS and thyroid diseases among the three groups (P＞0.05).ConclusionFor the RF-negative patients, the body is still in a state of high inflammatory response, and early attention should be paid to laboratory indicators and imaging abnormalities, early prediction of cardiovascular and cerebrovascular diseases and metabolic syndrome and other risk factors to help early diagnosis and precise intervention and treatment.
Keywords:rheumatoid arthritis/
rheumatoid factor/
titer/
laboratory index

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