类风湿关节炎与血清免疫学指标的相关性

目的探讨类风湿关节炎(RA)患者血清免疫球蛋白、补体水平与疾病的相关性。方法检测2013年2月至2014年2月该院RA患者的免疫球蛋白和补体水平,根据疾病活动性评分(DAS)28进行分组统计,并与病情活动程度的有关指标进行相关性分析。结果 RA活动组患者免疫球蛋白IgG、IgA、IgM水平高于对照组,补体C4的水平低于对照组,差异有统计学意义(P0.05);RA稳定组患者补体C3、C4较活动期患者更低。年龄、性别、病程等多因素校正后,IgA、C3与自身抗体类风湿因子(RF)、抗瓜氨酸化蛋白抗体(ACPA)、血沉(ESR)和C-反应蛋白(CRP)等多个指标相关,与DAS28的相关性独立于CRP。结论 RA患者血清免疫球蛋白和补体可辅助诊断RA和判断病情活动程度。     

类风湿关节炎患者血清14-3-3η蛋白、免疫球蛋白的变化及其意义

目的探讨类风湿关节炎(RA)患者血清免疫球蛋白、14-3-3η蛋白的变化及其意义。方法选取我院2015年2月—2017年12月收治的RA患者110例(RA组)和年龄、性别相匹配的健康对象40例(对照组),检测两组的血清IgA、IgG、IgM、补体C3、C4、14-3-3η蛋白水平,并根据RA患者是否处于疾病活动期和放射学分级进行分层分析。结果 RA组的血清IgG、14-3-3η蛋白水平显著高于对照组(P0.05),血清IgA、IgM、补体C3、C4蛋白水平与对照组比较差异无统计学意义(P0.05);活动期RA患者血清IgG、14-3-3η蛋白水平显著高于非活动期的RA患者(P0.05),血清IgA、IgM、补体C3、C4水平与非活动期的RA患者比较差异无统计学意义(P0.05);放射学分级3级、4级RA患者血清IgG、补体C3、14-3-3η蛋白水平显著高于非活动期组的2级患者(P0.05),血清IgA、IgM、补体C4水平与放射学分级2级RA患者比较差异无统计学意义(P0.05)。结论 RA患者血清IgG、补体C3 14-3-3η蛋白水平较高,血清14-3-3η蛋白、免疫球蛋白水平变化与RA患者病情、活动情况具有一定的相关性。     

类风湿关节炎患者血清IgG及亚类的水平和临床意义

目的探讨类风湿关节炎(RA)患者血清IgG及亚类的水平和临床意义。方法选择2018年10月至2019年6月该院风湿免疫科收治的RA患者54例纳入RA组,选择同期36例健康体检者纳入对照组。采用双抗体夹心法ELISA检测血清IgG亚类水平;采用免疫散射比浊法检测免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4)和类风湿因子(RF)水平;采用流式点阵免疫发光法检测抗环瓜氨酸肽(CCP)抗体水平。比较两组各检测指标水平,分析RA患者血清IgG亚类与IgG、IgA、IgM、C3、C4、RF及抗CCP抗体之间的相关性。结果RA组血清IgG、IgA、RF和抗CCP抗体水平显著高于对照组(P<0.05),但IgM、C3和C4水平差异无统计学意义(P>0.05)。RA组血清IgG1和IgG3水平显著高于对照组(P<0.05),两组血清IgG2和IgG4水平差异无统计学意义(P>0.05)。与对照组比较,RA组IgG1/IgG和IgG3/IgG显著升高(P<0.05),而IgG2/IgG显著下降(P<0.05)。Spearman相关分析显示,RA组患者血清IgG1水平与IgG呈高度正相关(r=0.865,P<0.05);IgG2、IgG3水平与IgG均呈中度正相关(r=0.613、0.644,P<0.05);IgG4水平与IgG呈低度正相关(r=0.271,P<0.05);IgG2水平与IgA呈低度正相关(r=0.399,P<0.05);IgG3水平与IgM呈低度正相关(r=0.343,P<0.05)。IgG各亚类与RF、抗CCP抗体之间均无相关性(P>0.05)。结论RA患者血清IgG水平显著升高,并且存在IgG亚类水平变化。IgG亚类检测对RA早期诊断价值有限。     

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。     

RA患者免疫功能失衡与疾病活动情况的关系研究

目的探讨类风湿关节炎(RA)患者免疫功能失衡与患者疾病活动程度的关系。方法选取我院类风湿免疫科确诊的RA患者90例(RA组)、健康体检志愿者60例作为对照组;检测两组对象外周血中Th17细胞、调节性T细胞(Treg)、血清γ干扰素(IFN-γ)、白细胞介素-4(IL-4)、C反应蛋白(CRP)、血沉(ESR),并分析Th17细胞、Treg、IFN-γ、IL-4与患者关节疼痛数目、类风湿关节炎病情评价(DAS28评分)的相关性。结果 RA组患者的Th17细胞、血清IFN-γ均高于对照组(P<0.05),RA组患者的Treg细胞低于对照组(P<0.05);RA组患者的血清CRP、ESR水平均高于对照组(P<0.05);DAS28评分>5.1分RA患者的Th17细胞、血清IFN-γ均高于≤5.1分的患者(P<0.05),DAS28评分>5.1分RA患者的Treg细胞低于≤5.1分的患者(P<0.05);RA患者的Th17细胞、血清IFN-γ与DAS28评分、压痛关节数目呈显著正相关(P<0.05),RA患者的Treg细胞与DAS28评分、压痛关节数目呈显著负相关(P<0.05)。结论 RA患者T细胞及免疫学因子失衡可能与患者疾病活动程度、病情严重程度有关。     

彝族人群类风湿关节炎患者甲状腺功能状况分析及临床意义

目的研究彝族人群类风湿性关节炎(rheumatoid arthritis,RA)患者伴发甲状腺功能异常的情况及临床意义。方法以确诊为RA的彝族人群患者42例为观察组,同期彝族人群健康体检者42例为对照组。采用化学发光分析法检测两组受试者甲状腺功能、促甲状腺激素和抗甲状腺自身抗体,常规检测实验室检查项目、免疫学指标等,并进行对比。对甲状腺功能正常与异常RA患者的疾病活动度、血沉、免疫球蛋白、补体、肝肾功能及血常规等进行比较。结果观察组甲状腺功能异常率(54.76%)、类风湿因子(rheumatoid factor,RF)阳性率(73.81%)、免疫球蛋白水平、甲状腺激素水平、抗甲状腺自身抗体值显著高于对照组(P<0.05);甲状腺功能正常与异常RA患者间RF阳性率、疾病活动度(DAS28)、血沉(ESR)、免疫球蛋白、补体、肝肾功能及血常规差异均无统计学意义(P>0.05)。结论彝族人群RA患者易出现甲状腺功能异常。     

血清免疫球蛋白和补体水平检测在类风湿性关节炎中的价值分析

目的 探讨血清免疫球蛋白和补体水平检测对类风湿性关节炎（RA）的诊断价值。方法 选取我院收治的80例RA患者及同期80例健康体检者分别设为病例组和对照组。两组血清免疫球蛋白（IgA、IgG、IgM）及补体（C3、C4）水平；按DAS28评分标准将病例组分为高度活动组23例、中度活动组24例、低度活动组18例、缓解组15例，对比病例组不同病情患者血清免疫球蛋白（Ig A、IgG、Ig M）及补体（C3、C4）水平；并观察病例组治疗前后血清免疫球蛋白（IgA、Ig G、IgM）及补体（C3、C4）水平变化。结果病例组血清IgA、IgG、IgM、C3及C4水平较显著高于对照组（P<0.05）。四组血清Ig A、Ig G、IgM、C3及C4水平比较，高度活动组明显高于中度活动组、低度活动组及缓解组，中度活动组明显高于低度活动组、缓解组，低度活动组明显高于缓解组（P<0.05）。治疗后，病例组血清IgA、IgG、IgM、C3及C4水平均明显下降（P<0.05）。结论 RA患者血清免疫球蛋白和补体水平呈高表达状态，其水平与患者病情活动度存在较高的相关性，对症治疗有助于调节其表达水...     

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。     

类风湿关节炎患者血清α-微管蛋白的检测及与临床实验室指标的相关性分析

目的利用酶联免疫吸附方法(ELISA)测定类风湿关节炎(RA)患者血清中的α-微管蛋白(α-tubulin)的水平,评价与临床实验室指标的关系,为寻找RA新的血清学标记物,探讨疾病的发病机制提供依据。方法选取RA患者68例,骨关节炎(OA)患者32例,健康对照(HC)32例,各取血清10μL,应用ELISA方法检测不同患者及健康对照血清α-tubulin水平,应用非配对资料的t检验分析不同患者与健康对照者之间α-tubulin水平的差异,相关性检验分析α-tubulin水平与RA患者年龄、病程、压痛关节数、肿胀关节数、红细胞沉降率(ESR)、C反应蛋白(CRP)水平、DAS28评分、类风湿因子(RF)水平、免疫球蛋白(Ig G、Ig A、Ig M)水平的相关性。结果 RA患者血清α-tubulin的水平明显高于骨关节炎患者及健康对照(P0.05),进一步分析提示α-tubulin水平与RA患者病程长短呈正相关(r=0.307,P=0.023),与血清类风湿因子水平及Ig A水平呈正相关(r=0.558,P=0.0001;r=0.395,P=0.004)。结论α-tubulin是RA新的血清学标记物,在RA患者的免疫反应中具有一定的意义,可能参与了RA的发病。     

56例类风湿关节炎患者手部影像学资料分析

目的：探讨类风湿关节炎患者（RA）手部X线的表现与临床病程的关系。方法：对56例临床资料完整的RA病例行双手的CR后前位X线检查,并按病程分为2组（A组为为符合类风湿关节炎X线I期表现的30例，B组为符合类风湿关节炎X线II期以上表现的病人26例），分别统计类风湿关节炎患者的活动性指标RF、ESR、CRP及免疫球蛋白的水平并进行两组比较。结果：两组RA患者的急性炎性反应指标ESR、CRP的数值两组比较，差异无显著性（P>0.05）。而类风湿因子及免疫球蛋白的水平，对照组明显高于研究组，两组差异具有显著性（P<0.05）。结论：类风湿关节炎的骨关节的损害的程度与RF和免疫球蛋白的水平有关，而手部X线的影像学检查在RA的早期诊断及判断预后方面具有重要的作用。     

Circulating complement breakdown products in patients with rheumatoid arthritis. Correlation between plasma C3d, circulating immune complexes, and clinical activity.

Quantitative determination of the small C3 breakdown product, C3d, was used to investigate complement activation in 45 plasma samples from 30 patients with rheumatoid arthritis (RA). The mean plasma C3e level in these samples (3.0 +/- 1.3 mg/100 ml) was significantly increased (P less than 0.001) as compared to patients with degenerative joint disease (0.9 +/- 0.4 mg/100 ml) and healthy blood donors (0.8 +/- 0.5 mg/100 ml). C3d levels were increased by more than s SD in 79% of RA samples. Plasma C3d levels were compared with C3d concentrations in synovial fluid. In most RA patients, the C3d levels were higher in synovial fluid than in plasma. A very significant correlation between plasma C3d levels and circulating immune complexes, as measured by determination of Clq binding activity (Clq BA), was observed (P less than 0.001). C3d levels were more elevated in RA patients with extra-articular disease manifestations (3.8 +/- 1.2 mg/100 ml) as compared to patients with joint disease alone (2.2 +/- 1.0 mg/100 ml). C3d levels and Clq BA were also significantly correlated (P less than 0.001) with the RA disease activity expressed by an index derived from sedimentation rate, joint score, and duration of morning stiffness. A close relationship between C3d levels, Clq BA, and the clinical activity further appeared during follow-up studies. The present observations suggest that a parallel but rather independent activation of the complement system may be induced by immune complexes in circulating blood and in the joint spaces during the course of rheumatoid arthritis.     

Abnormally-fucosylated serum haptoglobins in patients with inflammatory joint disease

The fucosylation of haptoglobins is altered in rheumatoid arthritis. In order to investigate the clinical usefulness of this finding, serum levels of abnormally-fucosylated haptoglobins (FHp) have been assessed in defined and matched groups of patients with different inflammatory joint diseases. FHp was elevated in 16/17 patients with active rheumatoid arthritis (RA); 1/20 patients with inactive rheumatoid arthritis; 1/11 patients with osteoarthritis; and 4/10 patients with seronegative polyarthritis. Raised FHp levels, therefore, are not disease-specific. There was no relationship between the duration of RA and the FHp level. The FHp expression in RA was also compared with other biochemical indices of disease activity. The degree of correlation between FHp and articular index, joint score and early-morning stiffness was very similar to that obtained for C reactive protein (CRP), and better than that obtained for erythrocyte sedimentation rate and haemoglobin. FHp, however, gives fewer false-positives than CRP in cases of inactive disease. until FHp can be measured more easily and cheaply, CRP estimation is still the biochemical test of choice in RA.     

类风湿关节炎患者血清白细胞介素-21水平检测及临床意义

目的检测类风湿关节炎(RA)患者血清中白细胞介素-21(IL-21)的水平,分析其临床意义。方法收集RA患者76例,采用双抗体夹心酶联免疫吸附试验(ELISA)检测RA患者及37例正常对照者血清IL-21水平,并分析血清IL-21水平与RA各临床及实验室指标的相关性。计量资料的比较采用Mann-Whitney U检验或单因素方差分析,相关性分析采用Spearman相关分析。结果 RA患者血清IL-21水平为86.5(64.1～130.1)pg/ml,明显高于正常对照组[65.0(40.0～90.3)pg/ml],差异有统计学意义(U=957.5,P=0.006);类风湿因子(RF)三个亚型IgM、IgA、IgG及抗环瓜氨酸肽(CCP)抗体阳性组RA患者血清IL-21水平与其自身抗体均呈正相关(r分别为0.300、0.382、0.370、0.372;P均<0.05)。RA患者RF(IgM、IgA)、CCP抗体阳性组血清IL-21水平显著高于阴性组[82.2(57.0～126.1)pg/ml]和76.9(52.0～201.4)pg/ml,U=176.5,P=0.024;95.4(62.1～144.6)pg/ml和70.6(43.0～110.8)pg/ml,U=282.5,P=0.016;82.9(51.0～145.1)pg/ml和76.5(63.4～144.6)pg/ml,U=333.0,P=0.031],差异有统计学意义。患者血清IL-21水平与触痛关节数(TEN28)及肿胀关节数(SW28)均呈正相关(r分别为0.342、0.200;P均<0.05),但IL-21与DAS28评分、C-反应蛋白、血沉、年龄、病程等均无明显相关性。结论 IL-21在RA患者血清中高表达,并与RF、抗CCP抗体密切相关,提示IL-21可能是RA发病机制的环节之一。     

Differential effects of age and illness duration on pain-depression and disability-depression relationships in rheumatoid arthritis

We examined the differential effects of age and illness duration on pain—depression and disability—depression relationships in a sample of patients diagnosed with rheumatoid arthritis (RA). Consistent with existing literature, main effect results indicated that shorter illness duration and greater perceived pain and functional disability all related to increased levels of depression. More importantly, multiple regression analyses revealed that illness duration moderated the observed disability—depression relationship. Specifically, perceived functional disability exerted a greater negative impact on levels of depression in patients with relatively shorter illness durations compared to patients with longer illness durations. Neither age nor illness duration moderated the association between pain and depression. In general, our findings suggest that age and illness duration differentially influence pain—depression and disability—depression relationships in RA. We conclude the paper with a discussion of treatment implications of our findings for persons with RA.     

Soluble interleukin-2 receptor: elevated levels in serum and synovial fluid of patients with rheumatoid arthritis

Soluble interleukin-2 receptor (sIL-2R) levels were quantitated in the serum and synovial fluid (SF) of patients with rheumatoid arthritis (RA) and degenerative joint disease (DJD). A sandwich immunoassay, employing two monoclonal antibodies against distinct epitopes on the IL-2R, was utilized for measurement. We found a striking elevation of sIL-2R in RA SF as compared with DJD SF (RA, 1319 +/- 135; DJD, 416 +/- 59; p less than 0.001). RA serum sIL-2R levels were also significantly elevated over DJD levels. There was no interaction between rheumatoid factor (RF) and sIL-2R. RA patients with elevated sIL-2R levels had significantly longer disease duration, higher c-reactive protein (CRP) levels in serum and SF, and higher RF levels in serum and SF. The groups were similar in regard to other laboratory variables. The presence of elevated levels of sIL-2R in RA serum and SF confirms the presence of a heightened immune reactivity and in vivo activation of lymphocytes in RA.     

白细胞介素-20在类风湿关节炎患者血清中的表达及影响因素探讨

目的探讨白细胞介素-20在类风湿关节炎患者血清中的表达及影响因素。方法根据病情,将50例类风湿性关节炎患者分为活动期类风湿性关节炎组、缓解期类风湿性关节炎组,并设立对照组,通过酶联免疫吸附法检测其血清白介素一20水平并与红细胞沉降率、c反应蛋白、晨僵时间等临床生化指标间的关系。结果与对照组相比,类风湿性关节炎患者血清白介素-20水平明显升高（P〈0．05）且以活动期类风湿性关节炎患者尤甚（P〈0．05）;血清白介素一20与晨僵时间、关节压痛指数、红细胞沉降率、c反应蛋白类风湿因子及x线分期均有相关性（P〈0．05）。结论IL一20可能与类风湿性关节炎的发生发展相关,并在一定程度上反映了类风湿性关节炎的活动情况。     

血清巨噬细胞移动抑制因子与类风湿关节炎活动性的关系

背景：巨噬细胞移动抑制因子作为肿瘤坏死因子a和白细胞介素1β的上游细胞因子，其调控作用在类风湿性关节炎发病机制中居重要地位。目的：分析血清巨噬细胞移动抑制因子与类风湿关节炎活动性的相关性。设计、时间及地点：非随机化同期对照及病例对照观察，于2005—09／200610在解放军白求恩国际和平医院完成。对象：选择门诊及住院类风湿性关节炎患者60例，另选同期健康者30例做对照组，其年龄、性别均与病例组匹配。方法：分析60例类风湿性关节炎患者的临床资料，根据DAS（disease activity score）积分将其分为类风湿性关节炎活动组及缓解组，并与30名正常人作对照。主要观察指标：①比较两组患者晨僵时间、关节压痛指数、关节肿胀指数、类风湿因子半定量、C反应蛋白、血沉、血小板计数。②采用双抗体夹心ELISA法检测血清巨噬细胞移动抑制因子浓度，比较类风湿性关节炎活动组、缓解组、健康对照组血清巨噬细胞移动抑制因子、白细胞介素1β、肿瘤坏死因子a水平。③分析类风湿性关节炎活动组血清巨噬细胞移动抑制因子水平与炎性指标、临床观察指标的相关性。结果：类风湿性关节炎活动组血清巨噬细胞移动抑制因子水平显著高于缓解组及正常对照组（P〈0．05），但缓解组较正常组差异无显著性意义（P〉0．05）。类风湿性关节炎活动组血清巨噬细胞移动抑制因子水平与炎性指标白细胞介素1β、肿瘤坏死因子α、血沉、C-反应蛋白、血小板计数以及关节肿胀指数和关节压痛指数均呈正相关，而与年龄、病程、晨僵时间和类风湿因子半定量则无相关性。结论：血清巨噬细胞移动抑制因子水平在类风湿性关节炎活动期显著增高，与炎性指标及关节肿痛呈正相关，提示可以作为类风湿性关节炎病情活动的血清标志物。     

Serum leptin levels in rheumatoid arthritis and relationship with disease activity

OBJECTIVES: This study was performed to evaluate serum leptin levels in rheumatoid arthritis (RA) patients and investigate the correlation with serum tumor necrosis factor alpha (TNF-alpha) levels and clinical and laboratory parameters of disease activity. METHODS: Fifty patients with RA and 34 control subjects were included. Disease activity score 28 (DAS28) was calculated for each patient. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Immunoradiometric assay was used for measuring serum leptin levels (ng/mL). Serum TNF-alpha levels (pg/mL) were measured by sandwich enzyme-linked immunosorbent assay method in 41 of 50 RA patients and in 24 control subjects. RESULTS: Age, sex and body mass index (BMI) did not show a statistically significant difference between RA and control subjects (P > 0.05). Serum leptin levels were higher in RA (P = 0.000). In RA patients, there were no correlations between serum leptin levels and disease duration, swollen and tender joint counts, DAS28, CRP, ESR, serum TNF-alpha levels, oral glucocorticoid and methotrexate usage (P > 0.05). There was no statistically significant serum leptin level difference between patients with high disease activity and mild and low disease activity (P = 0.892). Serum leptin levels positively correlated with BMI in both patient and control groups (P < 0.05). In both groups, mean serum leptin levels were higher in women than men. CONCLUSIONS: Even though serum leptin levels were found to be significantly higher in RA patients than in control subjects in this study, there was no correlation between serum leptin levels and TNF-alpha levels, clinical and laboratory parameters of disease activity. However serum leptin levels positively correlated with BMI in both patient and control groups. In RA, circulating leptin levels do not seem to reflect disease activity.     

活动期类风湿关节炎患者血清人类软骨糖蛋白-39水平测定的意义

目的研究活动期类风湿关节炎（RA）患者血清人类软骨糖蛋白-39（HC gp-39）的水平及意义。方法选取47例初诊活动期、42例非活动期RA患者和38名健康查体者,采用酶联免疫吸附试验（ELISA）测定血清HC gp-39水平,同时测定关节肿胀数（SJC）、关节压痛数（TJC）、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）等相关实验室指标。结果活动期RA患者血清HC gp-39水平明显高于非活动期RA患者及正常对照者（P〈0.01）。非活动期RA患者与正常对照者HC gp-39水平差异无统计学意义（P〉0.05）。不同X线分期患者HC gp-39水平差异有统计学意义（P〈0.05）,不同关节功能分级时差异无统计学意义（P〉0.05）。HCgp-39水平与SJC、TJC、ESR、CRP、关节X线分期呈正相关性（P〈0.01）,与年龄、病程、晨僵时间、RF、关节功能分级无明显相关性（P〉0.05）。结论 HC gp-39在活动期RA患者血清中呈高水平表达,可作为反映疾病活动和RA患者出现骨侵蚀的有益预测指标。