活动期类风湿关节炎患者血脂水平与疾病活动及骨侵蚀相关性研究

目的观察活动期类风湿关节炎(rheumatoid arthritis,RA)患者血脂水平与疾病活动性及骨侵蚀的相关性。方法选取活动期RA患者80例,另外选取40例健康体检者作为对照组,对RA组患者进行血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDLC)、低密度脂蛋白(Low density lipoprotein,LDLC)及血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)检测,并计算RA患者的疾病活动性评分(DAS28)、简化的疾病活动指数(SDAI)、临床疾病活动指数(CDAI)、双手X线Sharp评分;对健康对照组进行TC、TG、HDLC、LDLC检测。结果与正常对照组相比,活动期RA患者血清HDLC水平显著降低(P0.01),TC、TG、LDLC在两组中差异无统计学意义;HDLC与DAS28(ESR)、DAS28(CRP)、SDAI、CDAI、ESR、CRP呈负相关(P0.05或P0.01);TC、TG、LDLC与DAS28(ESR)、DAS28(CRP)、SDAI、CDAI、ESR、CRP无明显相关;TC、TG、HDLC、LDLC与Sharp评分无明显相关性。结论活动期RA患者体内血脂水平发生异常,HDLC可作为评价RA疾病活动性的指标,RA患者血脂水平与骨侵蚀无关。     

活动期类风湿关节炎患者前白蛋白的变化及意义

目的观察活动期类风湿关节炎(RA)患者的前白蛋白(PA)的变化及意义。方法 70例活动期RA患者为RA活动组,60例正常健康人为健康对照组,分别检测两组受试者的PA、总白蛋白(TP)、白蛋白(ALB)、球蛋白(GLO)及活动性指标,分析两组PA、TP、ALB、GLO的差异,并分析PA的变化与活动性指标的相关性。结果 (1)与健康对照组相比,RA活动期组PA、TP、ALB显著降低(P<0.05或P<0.01);(2)活动期RA患者蛋白质指标与疾病活动性相关指标相关性的比较,RA活动组PA、ALB与C反应蛋白(CRP)、血沉(ESR)呈明显负相关(P<0.05或P<0.01);GLO与疾病活动性呈明显正相关,以上各指标与年龄及病程无明显相关性。结论活动期RA患者PA、TP、ALB显著降低,PA、ALB、GLO的变化与感染、炎症及疾病活动度密切相关。     

铁储备与类风湿关节炎相关性研究

目的探讨铁储备与类风湿关节炎的临床相关性。方法入选60例活动期RA患者,设健康对照组20例,均检测血常规、血清铁(SI)、血清铁蛋白(SF)、转铁蛋白(TRF);RA患者同时观测疾病活动指标。结果RA组与健康对照组比较SI、SF和TRF显著下降,同时铁储备与活动期RA贫血指标、疾病活动指标呈明显相关性(P<0.05)。结论铁储备可以提示RA患者的贫血、疾病活动指标的变化,可以作为判断RA疾病活动、指导RA的治疗和预后的新指标。     

血清腺苷脱氨酶水平与类风湿关节炎患者疾病活动度的相关性研究

目的　探讨血清腺苷脱氨酶(adenosine deaminase,ADA) 水平与类风湿关节炎(rheumatoid arthritis,RA) 患者 疾病活动度的相关性。方法　选取86 例RA 患者为观察组,另选取同期86 例体检健康者作为对照组,采用欧洲抗风湿 联盟（the European League Against Rheumatism, EULAR）疾病活动指数28(disease activity score28-joint,DAS28) 将观察 组分为疾病缓解期和疾病活动期( 低活动度、中活动度和高活动度)。分析血清中ADA 的水平与疾病活动度的相关性。 结果　与对照组比较,观察组各期患者血清中ADA 水平显著升高,且差异具有统计学意义(F=3.407, P<0.05)。血清中 ADA 水平随着疾病活动度的增加而升高。与高活动度患者比较,疾病缓解期、低活动度、中活动度患者的ADA 水平 显著降低,且差异具有统计学意义(F=45.034, P<0.05)。相关性分析结果显示,血清中ADA 的水平与DAS28 呈正相关 关系(r=0.486, P<0.001)。ROC 曲线分析结果显示血清ADA 诊断RA 的敏感度、特异度分别为83.7% 和86.1%。血清 ADA 区分RA 活动期与缓解期的敏感度、特异度分别为72.9% 和85.2%。结论　血清ADA水平在RA患者中显著升高, 并且与疾病活动程度相关。因此,其可作为评估RA 患者疾病活动程度的参考指标。     

C-反应蛋白与类风湿关节炎疾病活动度的相关性研究

目的探讨C-反应蛋白(CRP)与类风湿关节炎疾病活动度的相关性。方法选择112例类风湿关节炎患者为观察组,其中62例为活动期患者,50例为非活动期患者,同时选择50例健康者为对照组,比较两组超敏C-反应蛋白(hs-CRP)、抗环瓜氨酸肽抗体(抗CCP)、类风湿因子(RF)及红细胞沉降率(ESR)的差别。结果观察组患者hs-CRP、抗CCP、RF及ESR水平明显高于对照组(P<0.01),活动期患者上述检测指标明显高于非活动期患者(P<0.01);观察组患者hs-CRP、抗CCP、RF与ESR显著相关(P<0.05)。结论 hs-CRP可作为类风湿关节炎疾病活动期的敏感指标之一,与抗CCP、RF及ESR联合检测对病情有预测价值。     

1型糖尿病患者血脂与糖尿病肾脏疾病的关系

目的探讨血脂与1型糖尿病肾脏疾病(DKD)的关系。方法采用横断面回顾性研究177例1型糖尿病(T1DM)患者相关资料,按照尿白蛋白/尿肌酐比值(UACR)水平分为3组:正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组。结果 (1)与正常白蛋白尿组比较:大量白蛋白尿组三酰甘油、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均明显升高,P 0. 05;(2) TC与舒张压(DBP)、UACR、体质指数(BMI)呈正相关,与C肽水平呈负相关;高密度脂蛋白胆固醇与糖化血红蛋白(HbA_1c)呈负相关,与C肽呈正相关; LDL-C与DBP、UACR、HbA_1c、BMI呈正相关;极低密度脂蛋白胆固醇(VLDL-C)与年龄和UACR呈正相关。(3) logistic回归分析结果显示TC、LDL-C是影响DKD发生的独立危险因素。结论脂代谢异常参与T1DM患者DKD的发生和发展。     

类风湿关节炎病人焦虑及抑郁情绪与疾病活动度的相关性

[目的]调查类风湿关节炎病人焦虑、抑郁情绪现状,并分析焦虑、抑郁情绪与疾病活动度的相关性。[方法]采用医院焦虑抑郁量表及疾病相关信息调查表对西安市某三级甲等医院235例类风湿关节炎病人进行问卷调查。[结果]类风湿关节炎病人焦虑得分为6.92分±4.21分,抑郁得分为5.86分±3.91分,41.7%的病人存在焦虑情绪,31.5%的病人存在抑郁情绪;疾病活动指数(DAS28)得分为0.49分~7.82分(3.71分±1.53分),处于缓解期57例(24.3%),轻度活动期35例(14.9%),中度活动期100例(42.6%),重度活动期43例(18.3%)。类风湿关节炎病人焦虑和抑郁得分与疾病活动度评分呈正相关(P0.05)。[结论]类风湿关节炎病人焦虑、抑郁情绪与疾病活动度有相关性,医护人员在关注病情活动的同时应注意缓解病人的焦虑、抑郁情绪,促进疾病康复。     

类风湿关节炎合并糖代谢异常患者的临床特征

目的 探讨类风湿关节炎(RA)合并糖代谢异常的临床特点及危险因素.方法 以311例RA患者为研究对象,分为单纯RA组、合并空腹血糖受损(IFG)组与合并2型糖尿病(T2DM)组,比较各组患者的临床资料,包括人口学特征;吸烟、饮酒习惯;体质量指数(BMI)、糖化血红蛋白(HbAlc)、空腹血糖(FPG)、总胆固醇(TC)...     

活动期类风湿关节炎载脂蛋白的变化及相关性分析

目的：观察活动期类风湿关节炎（RA）患者载脂蛋白的变化,并进行其相关性分析。方法：测定活动期RA患者60例（活动组）、缓解期RA患者20例（缓解组）及正常对照者20例（正常组）的载脂蛋白A1（ApoAl）、载脂蛋白B（ApoB）以及ApoAl／ApoB,比较是否存在差异;分析ApoAl、ApoB与脂质、蛋白代谢、活动性指标、临床症状、焦虑自评量表（SAS）、抑郁自评量表（SDS）标准分、生活质量及社会支持的相关性。结果：①活动组患者的ApoAl较正常组显著下降,60例中ApoAl下降21例（35．0％）。②ApoAl与年龄、社会支持总积分呈正相关,与食欲减退呈明显负相关;ApoB与年龄、SDS标准分呈正相关;ApoAl／ApoB与SDS标准分呈负相关。③ApoAl与总胆固醇、高密度脂蛋白、前白蛋白、总蛋白、白蛋白呈正相关,与血沉（ESR）、α1-酸性糖蛋白（α1—AGP）呈明显负相关;ApoB与甘油三脂、低密度脂蛋白呈明显正相关。结论：活动期RA患者中存在脂质代谢的异常,具体表现为ApoAl水平下降,其变化除与RA炎症活动有关。尚与抑郁情绪、蛋白代谢等有关。     

Calprotectin levels in rheumatoid arthritis and their correlation with disease activity: a meta-analysis

Objective: We evaluated the relationship between calprotectin levels and rheumatoid arthritis (RA), and the correlation between plasma/serum calprotectin and RA activity.

Methods: We searched PUBMED, EMBASE, and Cochrane databases and performed meta-analyses comparing plasma/serum or synovial fluid calprotectin levels in RA patients and controls, and correlation coefficients between calprotectin levels and disease activity for 28 joints (DAS28) as well as C-reactive protein (CRP) in RA patients.

Results: Sixteen studies including 849 RA patients and 266 controls were available for meta-analysis. Meta-analysis showed that calprotectin levels were significantly higher in the RA group than in the control group (SMD = 2.337, 95% CI = 1.544–3.130, p < 1.0 × 10^–8). Stratification by rheumatoid factor (RF) status revealed significantly elevated calprotectin levels in the RF-positive RA group compared to that of the RF-negative RA group (SMD = 0.574, 95% CI = 0.345–0.804, p = 9.2 × 10^–7). Meta-analysis of correlation coefficients identified a significant positive correlation between calprotectin levels and CRP or DAS28 (correlation coefficient for CRP = 0.566, 95% CI = 0.512–0.615, p < 1.0 × 10^–8; correlation coefficient for DAS28 = 0.438, 95% CI = 0.269–0.518, p = 2.5 × 10^–6). Calprotectin levels in synovial fluid were significantly higher in the RA group than in the control group (SMD = 2.891, 95% CI = 1.067–4.715, p = 0.002).

Conclusions: Our meta-analysis demonstrates that circulating and synovial fluid calprotectin levels are high in patients with RA, and that circulating calprotectin levels positively correlate with RA activity.     

Frequency of serological markers of rheumatoid arthritis in adult patients with active celiac disease

BackgroundCeliac disease (CD) and rheumatoid arthritis (RA) are multisystem autoimmune diseases affecting 1% of general populationa. Both diseases share genetic and immunological features.AimIn this retrospective study, we aim to determine the frequency of auto‐antibodies of RA in adult patients with CD.Materials and methodsSeventy seven adult patients with active CD were included in the present study. Ninety healthy blood donors (HBD) served as control group. Anti‐cyclic citrullinated peptides antibodies (CCP‐Ab) and rheumatoid factors (RF; IgA, IgG and IgM) were determined by enzyme linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi‐square or Fisher''s exact test.ResultsOur study included 77 adult patients with active celiac disease (57 female, 20 male). Twenty‐four (31.2%) active celiac patients and 7 (7.8%) blood donors had CCP‐Ab or RF (31.2% vs 7.8%, p < 10–4). Only two patients (2.6%) had both CCP‐Ab and RF. IgA was the predominant isotype of RF in celiac patients (n = 18; 23.4%) while none of healthy blood donors had RF‐IgA (23.4% vs 0.0%, p < 10–4).ConclusionThe current study has shown that CD is associated with a high frequency of RF‐IgA suggesting that celiac patients could be at a higher risk of developing RA.     

Regulatory and other rheumatoid factors in rheumatoid arthritis patients with active disease or in remission

BackgroundPreviously, we identified a regulatory rheumatoid factor (regRF), the production of which provides rats with resistance to collagen‐induced arthritis (CIA). Immunization with conformers of IgG Fc fragments carrying epitopes specific to regRF reduces symptoms of CIA. The aim of this study was to determine whether there is a link between regRF levels and rheumatoid arthritis (RA) activity in humans in order to assess the potential of regRF as a therapeutic biotarget in RA. The variability of rheumatoid factor (RF) specificities present in the blood of RA patients was also studied.MethodsThe regRF were studied in RA patients with active disease and in remission. Variability in the specificities of RF associated with RA was studied by concurrent inhibition of RF latex fixation by variants of modified IgG.ResultsPatients in remission had regRF levels higher than in healthy subjects. The regRF in remission was characterized by tight binding to its antigen, as in healthy subjects. The regRF levels in patients with active RA varied dramatically, and regRF binding to its antigen was weak. The exacerbation of Still''s disease coincided with low regRF levels and affinity, while an improvement in patient condition was associated with an increase in regRF levels and affinity. The RF specific to RA, which was detected by the RF latex‐fixation method, was a nonhomogeneous population of antibodies that included RF to lyophilized IgG, to IgG immobilized on polystyrene, and to rabbit IgG.ConclusionStimulating regRF production might enable improved RA therapy.     

补体C1q与类风湿关节炎活动度相关性研究

目的探讨血清补体C1q水平在类风湿关节炎(RA)活动度中的应用价值。方法收集160例RA患者(RA活动组110例,RA缓解组50例)和30例健康体检人群(健康对照组)的外周静脉血,测定其血清补体C1q水平,同时检测与RA疾病活动度相关指标红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)及环瓜氨酸肽(CCP)的表达,采用SPSS19.0软件进行比较分析。结果 RA活动组C1q、ESR、CRP水平高于RA缓解组和健康对照组,差异有统计学意义(P0.05),而RA缓解组与健康对照组C1q水平差异无统计学意义(P0.05),ESR、CRP与C1q比较,差异无统计学意义(P0.05);RA活动组RF阳性率高于RA缓解组和健康对照组,差异有统计学意义(P0.05),CCP阳性率高于健康对照组,但与RA缓解组比较,差异无统计学意义(P0.05),C1q与RF比较差异无统计学意义(P0.05),而与CCP比较差异有统计学意义(P0.05);C1q、ESR、CRP、RF与28-类风湿关节炎疾病活动分数(DAS28)呈显著相关(P0.05),CCP与DAS28无显著相关。结论补体C1q与RA活动度呈显著相关,可作为评价RA活动度的指标。     

Edaravone inhibits the disease activity in rheumatoid arthritis

A male patient with rheumatoid arthritis (RA) developed acute stroke and was treated with the free radical scavenger, edaravone. Polyarthralgia improved with a reduction in serum C-reactive protein concentration soon after the start of edaravone administration. The disease activity score 28 (DAS28) also decreased. Edaravone appears to be effective for the control of RA. The usefulness of this potentially novel therapeutic agent should be tested in a well designed randomized controlled trial.     

肌肉骨骼超声对类风湿关节炎疾病活动度的评估价值

目的探索肌肉骨骼超声对类风湿关节炎疾病活动度的评估价值。方法以2018年2月14日至2020年2月21日收治的172例疑似类风湿关节炎患者为研究对象,以病理诊断为金标准将患者分为类风湿关节炎组(阳性组,86例)和非类风湿关节炎组(阴性组,86例),均进行肌肉骨骼超声检查。分析肌肉骨骼超声的诊断效能。结果阳性组的血流信号分级总异常率显著高于阴性组(P<0.05)。高度活动障碍组的血流信号分级高于轻度活动障碍组、中度活动障碍组,滑膜厚度厚于轻度活动障碍组、中度活动障碍组(P<0.05)。肌肉骨骼超声对关节积液诊断准确率为95.24%,对滑膜肥厚/增生诊断准确率为96.15%。肌肉骨骼超声诊断的灵敏度、特异度、漏诊率、误诊率分别为96.51%、97.67%、3.49%、2.33%。结论在评估类风湿关节炎疾病活动度时,应用肌肉骨骼超声检查可提高诊断的准确率。     

Power Doppler assessment of overall disease activity in patients with rheumatoid arthritis

PURPOSE: To examine synovial vascularity and flow patterns in hand and wrist joints--metacarpophalangeal (MCP) joints and ulnar stiloid (USTL) regions--of patients with rheumatoid arthritis (RA) using power Doppler sonography (PDUS) and spectral Doppler analysis and to assess the accuracy of PDUS in detecting overall disease activity in RA patients. METHODS: Two hundred forty MCP joints and 48 USTL regions in 24 RA patients were examined. Patients were categorized into 2 groups--active and inactive--according to the American College of Rheumatology remission criteria. Resistance indexes (RIs) were measured. RESULTS: Flow signals were detected in 50 MCP joints (in 13 patients) and 24 USTL regions (in 16 patients) and spectral analysis was performed in 46 MCP joints (12 patients) and 23 USTL regions (16 patients). The sensitivity and specificity of PDUS in detecting disease activity in RA were 92% and 40%, respectively. There was a negative correlation between flow signal number and RI, with higher scores of flow signals corresponding to lower RIs. CONCLUSION: PDUS appears to be a reliable method for assessing inflammatory activity in rheumatoid synovium.     

类风湿性关节炎患者自身抗体的检测及应用

目的探讨抗核抗体（ANA）检测在类风湿性关节炎（RA）诊断中的意义。方法随机选取该院2010～2013年收治的RA患者67例,以间接免疫荧光法及免疫印迹发检测ANA,以速率散射免疫比浊法检测类风湿因子（RF）,并分析ANA和RF在诊断RA中的相关性。结果检测ANA有利于RA的诊断。67例标本中抗-nRNP／Sm、抗-SS-A、抗一组蛋白阳性率最高,分别为21％、18％、18％。RA组ANA核型主要为均质型,其次为颗粒型,也有部分为阴性。结论临床上治疗RA患者时,应注意监测是否同时患有多重自身免疫性疾病。     

早期类风湿性关节炎手功能障碍与关节内炎症相关性分析

目的 探讨早期类风湿性关节炎(RA)手功能障碍(SOFI)与关节内炎症之间相关性。 方法 分析63例早期RA伴手功能障碍患者临床及超声资料,分析SOFI评分、晨僵视觉评分(MS-VAS)与关节内滑膜炎、腱鞘炎、关节腔积液及炎症总评分之间相关性。 结果 滑膜炎与SOFI之间有显著相关性(GSUS:rs=0.46,P=0.01,PDUS：rs=0.51,P=0.003),而与MS-VAS之间没有显著相关性(GSUS:rs=0.28,P=0.14,PDUS：rs=0.35,P=0.06);腱鞘炎与MS-VAS之间有显著相关性(rs=0.39,P=0.03),而与SOFI之间没有显著相关性(rs=0.29,P=0.12);关节腔积液与SOFI(rs=0.12,P=0.36)及MS-VAS(rs=0.16,P=0.32)之间均无显著相关性;关节内炎症总评分则与SOFI(rs=0.53,P=0.002)及MS-VAS(rs=0.47,P=0.008)之间均有显著相关性。 结论 早期RA患者手功能障碍(SOFI)与关节内滑膜炎相关,晨僵则与腱鞘炎相关,超声提示的滑膜炎、腱鞘炎能更加全面地反应早期RA手腕部关节功能。