抗环瓜氨酸肽抗体和类风湿因子双阳性类风湿关节炎患者临床资料分析

目的：探讨抗环瓜氨酸肽抗体（抗CCP抗体）和类风湿因子（RF）双阳性与类风湿关节炎（RA）患者的疾病活动度、骨侵蚀等临床指标的相关性。方法收集2011年1月至2012年2月安徽医科大学风湿免疫科确诊的住院RA患者360例。详细记录RA患者的各临床及实验室指标，并对其中266例RA患者双手X线片做Sharp评分。采用t检验、χ2检验、秩和检验和多元Logistic Regression回归进行统计学处理。结果（1）360例RA患者中，抗CCP抗体阳性274例（76.1%），RF阳性279例（77.5%）；241例患者（66.9%）抗 CCP 抗体、RF 均阳性，46例患者（12.8%）抗 CCP 抗体、RF 均阴性。（2）抗CCP抗体阳性组和阴性组间比较，抗CCP抗体阳性患者关节肿胀数更多（8.82±5.91 vs.7.14±5.56），关节功能（χ2＝10.216，P＝0.017）更差，肿胀指数（9.22±6.05 vs.7.43±5.68）、HAQ（1.61±0.67 vs.1.34±0.75）、Sharp评分（61.92±64.63 vs.45.98±53.10）、DAS28（5.44±1.28 vs.5.07±1.06）比阴性患者更高，两者之间差异有统计学意义（P＜0.05）。（3）抗CCP和RF双阳性组和阴性组间比较，抗CCP抗体和RF双阳性的RA患者的关节肿胀数（9.12±6.07 vs.6.97±5.15）和关节压痛数（12.76±7.83 vs.10.48±7.27）更多，肿胀指数（9.54±6.21 vs.7.26±5.26）和压痛指数（17.94±12.08 vs.14.34±10.19）更高，关节功能更差（χ2＝10.890，P＝0.012），HAQ（1.63±0.66 vs.1.38±0.75）、ESR（64.08±33.95）mm/1 h vs.（50.86±35.17） mm/1 h]、DAS28更高（5.54±1.26 vs.4.96±1.18）（P＜0.05）。（4）相关分析显示：血清抗CCP抗体水平与DAS28评分、ESR呈正相关（r＝0.123，P＝0.033；r＝0.160，P＝0.004），而DAS28又与Sharp评分、CRP、HAQ、晨僵时间、关节肿胀数、关节压痛数等指标呈正相关（P＜0.05）。结论抗 CCP 抗体和RF双阳性RA患者的疾病活动性更高，关节功能等指标更差，RA患者抗CCP抗体水平与疾病活动度及骨侵蚀严重程度相关。

The clinical data analysis of Anti-CCP and RF-positive patients with rheumatoid arthritis

Objective To investigate associations of anti-cyclic citrullinated peptide antibody （anti-CCP antibodies） and rheumatoid factor （RF）-positive patients with rheumatoid arthritis （RA） with bone erosion and other clinical features. Methods Three hundred and sixty in-patients with RA between 2010 and 2012 were surveyed, the radiographic changes in both hands of 266 RA patients were assessed by Sharp＇ method. All the clinical and laboratory factors of RA were recorded in detail by rheumatologist. t-test,χ2 test, rank test and Logistic Regression were used for statistical analysis. Results （1） The positive rates of anti-CCP antibody in patients with RA were 76.1%（274/360）, the anti-CCP antibody and RF positive rates were 66.9% （241/360）. （2） Comparison between anti-CCP antibody positive group and negative group, the joint swelling number were more （8.82±5.91 vs. 7.14±5.56）, worse function of joint （χ2=10.216,P=0.017）, swelling index （9.22±6.05 vs.7.43±5.68）, HAQ （1.61±0.67 vs. 1.34±0.75）, Sharp score （61.92±64.63 vs. 45.98±53.10）, DAS28 （5.44±1.28 vs. 5.07±1.06） was higher than negative patients, and there had obvious difference between with statistical significance（P〈0.05）. （3）Patients determined as anti-CCP antibody and RF positive had more joint swelling number （9.12±6.07 vs. 6.97±5.15）, more joint tenderness （12.76±7.83 vs. 10.48±7.27）, higher swelling index and the pressure index, worse of joint function, higher HAQ （1.63±0.66 vs. 1.38±0.75）, ESR（64.08±33.95）mm/1 h vs.（50.86±35.17）mm/1 h] and DAS28 （5.54±1.26 vs. 4.96±1.18）（all P〈0.05）. （4） Logistic regression analysis indicate：the serum anti-CCP antibody levels and DAS28 score, the ESR were positively correlated （r=0.123, P=0.033;r=0.160, P=0.004）, DAS28 and Sharp score, CRP, HAQ, time of morning stiffness, joint swelling count, joint tenderness such as index were positively correlated （P〈0.05）. Conclusion Anti-CCP antibody and RF positive RA patients have higher disease activity, worse joint function indicators, RA patients with anti-CCP antibody levels associated with the severity of disease activity and bone erosion.