摘要
目的本研究通过RA真实世界的大规模研究旨在比较中国RA血清阳性和血清阴性患者临床特征和预后。方法纳入2015年9月至2020年1月于全国10家医院就诊的符合1987年ACR分类标准或2010年ACR/ELUAR RA分类标准的RA患者。根据血清学状态,将患者分为4个亚组[RF(-)抗CCP抗体(-)、RF(+)抗CCP抗体(+)、RF(+)抗CCP抗体(-)、RF(-)抗CCP抗体(+)],并比较疾病特征和治疗反应。符合正态分布的计量资料采用单因素方差分析,不符合正态分布的采用Kruskal-Wallis H检验,各组内治疗前后比较符合正态分布采用配对t检验,不符合正态分布的采用配对秩和检验;计数资料采用χ^(2)检验。结果①共纳入患者2461例,其中RF(+)抗CCP抗体(+)患者1813例(73.67%),RF(+)抗CCP抗体(-)患者129例(5.24%),RF(-)抗CCP抗体(-)患者245例(9.96%),RF(-)抗CCP抗体(+)患者274例(11.13%)。②无论抗CCP抗体是否阳性,RF(+)患者发病早[RF(-)抗CCP抗体(-)(51±14)岁,RF(-)抗CCP抗体(+)(50±15)岁,RF(+)抗CCP抗体(+)(48±14)岁,RF(+)抗CCP抗体(-)(48±13)岁,F=3.003,P=0.029],病程长[RF(-)抗CCP抗体(-)50(20,126)个月,RF(-)抗CCP抗体(+)60(24,150)个月,RF(+)抗CCP抗体(+)89(35,179)个月,RF(+)抗CCP抗体(-)83(25,160)个月,H=22.001,P<0.01],关节肿胀数(SJC)[RF(-)抗CCP抗体(-)2(0,6),RF(-)抗CCP抗体(+)2(0,5),RF(+)抗CCP抗体(+)2(0,7),RF(+)抗CCP抗体(-)2(0,6),H=8.939,P=0.03]、关节触痛数多[RF(-)抗CCP抗体(-)3(0,8),RF(-)抗CCP抗体(+)2(0,6),RF(+)抗CCP抗体(+)3(1,9),RF(+)抗CCP抗体(-)2(0,8),H=11.341,P=0.01],晨僵时间长[RF(-)抗CCP抗体(-)30(0,60)min,RF(-)抗CCP抗体(+)20(0,60)min,RF(+)抗CCP抗体(+)30(10,60)min,RF(+)抗CCP抗体(-)30(10,60)min,H=13.32,P<0.01];同时RF+患者的ESR[RF(-)抗CCP抗体(-)17(9,38)mm/1 h,RF(-)抗CCP抗体(+)20(10,35)mm/1 h,RF(+)抗CCP抗体(+)26(14,45)mm/1 h,RF(+)抗CCP抗体(-)28(14,50)mm/1 h,H=37.084,P<0.01]及CRP[RF(-)抗CCP抗体(-)2.3(0.8,15.9)mg/L,RF(-)抗CCP抗体(+)2.7(0.7,12.1)mg/L,RF(+)抗CCP抗体(+)5.2(1.3,17.2)mg/L,RF(+)抗CCP抗体(-)5.2(0.9,16.2)mg/L,H=22.141,P<0.01]明显高于RF(-)患者组,且拥有更高的疾病活动度[RF(-)抗CCP抗体(-)(4.0±1.8),RF(-)抗CCP抗体(+)(3.8±1.6),RF(+)抗CCP抗体(+)(4.3±1.8)岁,RF(+)抗CCP抗体(-)(4.1±1.7)岁,F=7.269,P<0.01]。③将RF(+)抗CCP抗体(+)患者分成4个亚组,结果发现RF高滴度(RF-H)抗CCP抗体低滴度(抗CCP抗体-L)患者的疾病严重程度更高(DAS28-ESR)[RF-H/抗CCP抗体-H 4.3(2.9,5.6),RF-L/抗CCP抗体-L4.5(3.0,5.7),RF-H/抗CCP抗体-L 4.9(3.0,6.2),RF-L/抗CCP抗体-H 2.8(1.8,3.9),H=20.374,P<0.01]。④随访3个月后,4组患者的临床特征变化均有不同程度的改善,但4组患者的改善程度差异无统计学意义,说明用药3个月时RF及抗CCP抗体状态未影响患者疾病活动度的改善情况。结论RA患者的疾病活动度与RF存在密切关系,RF(+)患者的疾病活动度明显高于RF(-)患者,RF高滴度患者的疾病严重程度高于RF低滴度患者;用药3个月后,抗体状态并未影响疾病缓解率。
Objective In general,patients with seropositive rheumatoid arthritis(RA)are considered to show an aggressive disease course.However,the relationship between the two subgroups in disease severity is controversial.Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods RA patients who met the 1987 American College of Rheumatology(ACR)classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria,and who attended the 10 hospitals across the country from September 2015 to January 2020,were enrolled.According to the serological status,patients were divided into 4 subgroups[rheumatoid factor(RF)(-)anti-cyclic citrullinated peptide(CCP)antibody(-),RF(+),RF(+)anti-CCP antibody(+),anti-CCP antibody(+)]and compared the disease characteristics and treatment response.One-way analysis of variance was used for measurement data that conformed to normal distribution,Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution;paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used;χ^(2) test was used for count data.Results①A total of 2461 patients were included,including 1813 RF(+)anti-CCP antibody(+)patients(73.67%),129 RF(+)patients(5.24%),245 RF(-)anti-CCP antibody(-)patients(9.96%),74 anti-CCP antibody(+)patients(11.13%).②Regardless of the CCP status,RF(+)patients had an early age of onset[RF(-)anti-CCP antibody(-)(51±14)years old,anti-CCP antibody(+)(50±15)years old,RF(+)anti-CCP antibody(+)(48±14)years old,RF(+)(48±13)years old,F=3.003,P=0.029],longer disease duration[RF(-)anti-CCP antibody(-)50(20,126)months,anti-CCP antibody(+)60(24,150)months,RF(+)anti-CCP antibody(+)89(35,179)months,RF(+)83(25,160)months,H=22.001,P<0.01],more joint swelling counts(SJC)[RF(-)anti-CCP antibody(-)2(0,6),Anti-CCP antibody(+)2(0,5),RF(+)anti-CCP antibody(+)2(0,7),RF(+)2(0,6),H=8.939,P=0.03]and tender joint counts(TJC)[RF(-)anti-CCP antibody(-)3(0,8),anti-CCP antibody(+)2(0,6),RF(+)anti-CCP antibody(+)3(1,9),RF(+)2(0,8),H=11.341,P=0.01]and the morning stiff time was longer[RF(-)anti-CCP antibody(-)30(0,60)min,anti-CCP antibody(+)20(0,60)min,RF(+)anti-CCP antibody(+)30(10,60)min,RF(+)30(10,60)min,H=13.32,P<0.01];ESR[RF(-)anti-CCP antibody(-)17(9,38)mm/1 h,anti-CCP antibody(+)20(10,35)mm/1 h,RF(+)anti-CCP antibody(+)26(14,45)mm/1 h,RF(+)28(14,50)mm/1 h,H=37.084,P<0.01]and CRP[RF(-)anti-CCP antibody(-)2.3(0.8,15.9)mm/L,Anti-CCP antibody(+)2.7(0.7,12.1)mm/L,RF(+)anti-CCP antibody(+)5.2(1.3,17.2)mm/L,RF(+)5.2(0.9,16.2)mm/L,H=22.141,P<0.01]of the RF(+)patients were significantly higher than RF(-)patients,and RF(+)patients had higher disease severity(DAS28-ESR)[RF(-)anti-CCP antibody(-)(4.0±1.8),anti-CCP antibody(+)(3.8±1.6),RF(+)anti-CCP antibody(+)(4.3±1.8),RF(+)(4.1±1.7),F=7.269,P<0.01].③The RF(+)anti-CCP antibody(+)patients were divided into 4 subgroups,and it was found that RF-H anti-CCP antibody-L patients had higher disease severity[RF-H anti-CCP antibody-H 4.3(2.9,5.6),RF-L anti-CCP antibody-L 4.5(3.0,5.7),RF-H anti-CCP antibody-L 4.9(3.1,6.2),RF-L anti-CCP antibody-H 2.8(1.8,3.9),H=20.374,P<0.01].④After 3-month follow up,the clinical characteristics of the four groups were improved,but there was no significant difference in the improvement of the four groups,indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months.Conclusion Among RA patients,the disease activity of RA patients is closely related to RF and the RF(+)patients have more severe disease than RF(-)patients.Patients with higher RF titer also have more severe disease than that of patients with low RF titer.After 3 months of medication treatment,the antibody status does not affect the disease remission rate.
作者
金晔华
姜婷
范晓蕾
汪荣盛
章渊源
程鹏
秦盈盈
洪梦婕
郭梦如
程青青
刘兆宜
张润润
常岑
许玲夏
许林帅
古英
胡春蓉
苏晓
薛鸾
方勇飞
苏励
高明利
彭江云
魏强华
沈杰
朱琦
刘红霞
何东仪
Jin Yehua;Jiang Ting;Fan Xiaolei;Wang Rongsheng;Zhang Yuanyuan;Cheng Peng;Qin Yingying;Hong Mengjie;Guo Mengru;Cheng Qingqing;Liu Zhaoyi;Zhang Runrun;Chang Cen;Xu Lingxia;Xu Linshuai;Gu Ying;Hu Chunrong;Su Xiao;Xue Luan;Fang Yongfei;Su Li;Gao Mingli;Peng Jiangyun;Wei Qianghua;Shen Jie;Zhu Qi;Liu Hongxia;He Dongyi(Department of Arthrology,Shanghai Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052;Institute of Arthritis Research in Integrative Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052;Department of Rheumatology,Mianyang Hospital of T.C.M,Sichuan 621000;Department of Rheumatology,The Ninth People's Hospital of Chongqing,Chongqing 400700;Department of Rheumatology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai 200071;Department of Rheumatology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437;Department of Traditional Chinese Medicine and Rheumatology,the First Hospital Affiliated To AMU(Southwest Hospital),Chongqing 400038;Department of Rheumatology,Longhua Hospital Shanghai University of Traditional Chinese Medicine,Shanghai 20032;Department of Rheumatology,Liaoning Provincial Hospital of Traditional Chinese Medicine,Shenyang 110000;Department of Rheumatology,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021;Department of Traditional Chinese Medicine,The First People's Hospital Affiliated with Shanghai Jiao Tong University,Shanghai 200080;Center for Drug Clinical Reasearch,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2021年第5期307-315,共9页
Chinese Journal of Rheumatology
基金
国家科学自然基金面上项目(81774114)
上海市中西医临床协作试点建设项目(ZY(2018-2020)-FWTX-1010)
上海市中医专科联盟建设项目(ZY(2018-2020)-FWTX-4017)。
关键词
抗环瓜氨酸肽抗体
类风湿因子
关节炎
类风湿
临床特征
Anti-cyclic citrullinated peptide antibody
Rheumatoid factor
Arthritis,rheumatoid
Clinical features
