类风湿因子或抗环瓜氨酸化多肽抗体阳性银屑病关节炎患者的临床特点

doi:10.19723/j.issn.1671-167X.2019.06.005

摘要/Abstract

摘要：

目的分析类风湿因子(rheumatoid factor,RF)或抗环瓜氨酸化多肽(cyclic-citrullinated peptide,CCP)抗体阳性银屑病关节炎(psoriatic arthritis,PsA)患者的临床和实验室检查特点。方法共纳入2007年1月至2019年6月于北京大学第三医院风湿免疫科住院的PsA患者77例,所有患者均符合2006年美国风湿病学会修订的《银屑病关节炎的分类诊断标准》或《Moll和Wright标准》,并进行了RF及抗CCP抗体检测,根据血清中是否检测到抗CCP抗体或RF将所有患者分为抗CCP抗体或RF阳性组15例、抗CCP抗体或RF阴性组62例;根据血清中是否检测到抗CCP抗体将所有患者分为抗CCP抗体阳性组7例、抗CCP抗体阴性组70例,收集患者的临床及实验室资料,比较RF或抗CCP抗体阳性和阴性PsA患者的临床及实验室指标的差异,并单独比较了抗CCP抗体阳性和阴性PsA患者的临床及实验室指标的差异。结果在77例患者中,RF或抗CCP抗体阳性者15例,其中仅RF阳性者8例,仅抗CCP抗体阳性者2例,两者均为阳性者5例。RF或抗CCP抗体阳性组PsA患者年龄较阴性组大[(58.2±14.8)岁 vs.(46.69±12.27)岁,P=0.002],更易出现掌指关节、肘关节、肩关节受累。抗CCP抗体阳性组PsA患者较阴性组年龄大[(62.43±14.34)岁vs.(47.59±12.75)岁,P=0.005],RF阳性率高,血纤维蛋白原水平高。抗CCP抗体阳性组PsA患者均为多关节炎,阴性组患者中有68.6%的患者为多关节炎,但两组间差异无统计学意义。RF或抗CCP抗体阳性和阴性以及抗CCP抗体阳性和阴性组PsA患者在腊肠指/趾表现、关节骨质破坏、指/趾甲改变、附着点炎方面差异无统计学意义。结论部分PsA患者血清中可检测到RF或抗CCP抗体;RF或抗CCP抗体阳性PsA患者更易出现掌指关节、肘关节、肩关节受累,年龄更大;抗CCP抗体阳性PsA患者年龄更大,RF阳性率、纤维蛋白原水平高。

关键词: 银屑病关节炎, 类风湿因子, 抗环瓜氨酸化多肽抗体

Abstract:

Objective: To analyze the clinical and laboratory features of psoriatic arthritis (PsA) patients with positive rheumatoid factor(RF)or anti-cyclic citrullinated peptide(CCP)antibody.Methods: In the study, 77 PsA patients who were hospitalized in the Department of Rheumatology and Immunology of Peking University Third Hospital from January 2007 to June 2019 were enrolled. All the patients met Classification Criteria for Psoriatic Arthritis or Moll or Wright Criteria. Rheumatoid factor (RF) and anti-cyclic-citrullinated peptide (CCP) antibody were tested in these patients. According to whether anti-CCP antibody or RF was detected in serum, all the patients were divided into anti-CCP antibody or RF positive group (15 cases), anti-CCP antibody or RF negative group (62 cases). According to the detection of anti-CCP antibody in serum, all the patients were divided into anti-CCP antibody positive group (7 cases) and anti-CCP antibody negative group (70 cases). Clinical and laboratory data were collected. The differences of clinical and laboratory indicators between the RF or anti-CCP antibody positive and negative PsA patients were compared. Clinical and laboratory indicators between the anti-CCP antibody positive and negative patients were also compared.Results: Among the 77 patients, 15 were RF or anti-CCP antibody positive, of whom 8 were only RF positive and 2 were only anti-CCP antibody positive, and both of RF and anti-CCP antibody were positive in 5 cases. The RF or anti-CCP antibody positive PsA patients were older than those in the negative group [(58.2±14.8) years vs.(46.69±12.27)years, P=0.002]. And metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. PsA patients in the anti-CCP antibody positive group were older than those in the negative group [(62.43±14.34) years vs.(47.59±12.75)years old, P=0.005]. The positive rate of RF and serum level of fibrinogen in the anti-CCP antibody positive group were higher than those in the negative group. The PsA patients in the anti-CCP antibody positive group were all polyarthritis, while 68.6% patients in the negative group were polyarthritis, but there was no statistical difference between the two groups. There was no statistical difference in sausage fingers/toes, changes in nails and enthesitis, and bone erosion on radiographs between the RF or anti-CCP antibody positive and negative PsA patients. There was also no statistical difference in sausage fingers/toes,bone erosion on radiographs,and changes in nails and enthesitis between the anti-CCP antibody positive and negative patients.Conclusion: RF and anti-CCP antibodies can be detected in the serum of some PsA patients. RF or anti-CCP antibody positive PsA patients were older than those in negative PsA patients. Metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. Anti-CCP antibody positive PsA patients were older and had higher levels of RF positive rate and fibrinogen level.

Key words: Psoriatic arthritis, Rheumatoid factor, Anti-cyclic citrullinated peptide antibody

中图分类号:

R593.2

代丽怡,巩丹丹,赵金霞. 类风湿因子或抗环瓜氨酸化多肽抗体阳性银屑病关节炎患者的临床特点[J]. 北京大学学报（医学版）, 2019, 51(6): 1008-1013.

Li-yi DAI,Dan-dan GONG,Jin-xia ZHAO. Clinical characteristics of psoriatic arthritis with positive rheumatoid factor or anti-cyclic citrullinated peptide antibody[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1008-1013.

图/表 6

表1

RF或抗CCP抗体阳性及阴性PsA患者基本情况的比较"

Items	Positive group(n=15)	Negative group(n=62)	P
Male,n(%)	9(60.0)	35(56.45)	0.803^*
Age /years, $x ? ± s$	58.2±14.8	46.69±12.27	0.002
The course of psoriasis/years, $x ? ± s$	15.04±12.57	13.79±12.41	0.727
The course of arthritis/years, $M$ (Min, Max)	2(0.08,18.00)	1(0.02,20.00)	0.517

表1

表2

表3

RF或抗CCP抗体阳性及阴性PsA患者实验室及影像学检查的比较"

Items	Seropositive group(n=15)	Seronegative group(n=62)	P
ESR/(mm/h), $x ? ± s$	55.15±30.89(n=13)	39.09±30.51(n=55)	0.067
CRP/(mg/L), $x ? ± s$	46.95(2.10, 173.00)(n=14)	24.70(1.00, 551.00)(n=59)	0.245
IgG/(g/L), $x ? ± s$	15.97±4.44(n=12)	13.47±3.02(n=45)	0.054
IgA/(g/L), $x ? ± s$	3.25±1.52(n=12)	3.23±1.28(n=46)	0.963
IgM/(g/L), $x ? ± s$	1.35±1.05(n=11)	1.15±0.53(n=45)	0.789
Fibrinogen/(g/L), $x ? ± s$	4.97±1.51(n=12)	4.38±1.38(n=44)	0.231
D-dimer/(mg/L), M(Min, Max)	0.78(0.11, 2.86)(n=12)	0.31(0, 2.76)(n=42)	0.121
Bone erosion on radiograph,n(%)	4(33.3)(n=12)	19(35.8)(n=53)	1.000^#

表3

表4

抗CCP抗体阳性及阴性PsA患者一般情况的比较"

Items	Anti-CCP antibody positive group (n=7)	Anti-CCP antibody negative group (n=70)	P
Male,n(%)	5(71.4)	39(55.7)	0.689^#
Age /years, $x ? ± s$	62.43±14.34	47.59±12.75	0.005
The course of psoriasis/years, $x ? ± s$	13.14±6.20	14.13±12.85	0.873
The course of arthritis/years, M(Min, Max)	2(0.83, 18)	1(0.02, 20)	0.871
Duration between skin onset and arthritis onset/years, M(Min, Max)	7.9(-1, 20)(n=7)	9.3(-2, 45)(n=64)	0.825

表4

表5

表6

抗CCP抗体阳性及阴性PsA患者实验室及影像学检查的比较"

Items	Anti-CCP antibody positive group(n=7)	Anti-CCP antibody negative group(n=70)	P
RF positive, n(%)	5(71.4)	8(11.4)	<0.001^#
ESR/(mm/h), $x ? ± s$	58.33±40.02(n=6)	40.60±29.95(n=62)	0.283
CRP/(mg/L), M(Min, Max)	69.2(2.1, 173.0)(n=7)	23.9(1.0, 551.0)(n=66)	0.459
IgG/(g/L), $x ? ± s$	13.90±4.10(n=5)	14.01±3.46(n=52)	0.902
IgA/(g/L), $x ? ± s$	3.57±2.02(n=5)	3.20±1.26(n=53)	0.687
IgM/(g/L), $x ? ± s$	1.50±1.58(n=5)	1.16±0.52(n=51)	0.635
Fibrinogen/(g/L), $x ? ± s$	5.87±1.30(n=4)	4.40±1.38(n=52)	0.048
D-dimer(mg/L), M(Min, Max)	0.92(0.59, 2.86)(n=4)	0.31(0, 2.76)(n=50)	0.071
Bone erosion on radiograph, n(%)	3(42.9)(n=7)	20(34.5)(n=58)	0.985^#

表6

参考文献 15

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Items	Positive group(n=15)	Negative group(n=62)	P
Shoulder joint involvement, n(%)	9(60.0)	16(25.8)	0.026^#
Elbow joint involvement, n(%)	7(46.7)	11(17.7)	0.042^#
Wrist joint involvement, n(%)	10(66.7)	26(41.9)	0.085^*
MCP joint involvement, n(%)	11(73.3)	24(38.7)	0.016^*
PIP joint involvement, n(%)	12(80.0)	33(53.2)	0.059^*
DIP joint involvement, n(%)	6(40.0)	22(35.5)	0.744^*
Hip joint involvement, n(%)	2(13.3)	7(11.3)	1.000^#
Knee joint involvement, n(%)	11(73.3)	36(58.1)	0.277^*
Ankle joint involvement, n(%)	6(40.0)	20(32.3)	0.569^*
MTP joint involvement, n(%)	8(53.3)	23(37.1)	0.250^*
PIP joint involvement of foot, n(%)	1(6.7)	15(24.2)	0.252^#
DIP joint involvement of foot, n(%)	0(0.0)	9(14.5)	0.262^#
Spinal involvement, n(%)	2(13.3)	7(11.3)	1.000^#
Sacroiliac joint involvement, n(%)	2(13.3)	12(19.4)	0.865^#
More than 3 articular regions involvement (14 articular regions), n(%)	13(86.7)	42(67.7)	0.255^#
Wrist, MCP or PIP (hand) joint involvement, n(%)	14(93.3)	47(75.8)	0.252^#
Symmetrical arthritis, n(%)	12(80.0)	34(54.8)	0.075^*
Oligoarthritis (4 or less joints involved) , n(%)	2(13.3)	17(27.4)	0.423^#
Sausage fingers/toes, n(%)	5(33.3)	18(30.5)(n=59)	1.000^#
Changes in nails, n(%)	6(50.0)(n=12)	12(27.9)(n=43)	0.274^#
Enthesitis, n(%)	2(16.7)(n=12)	15(34.9)(n=43)	0.393^#
Psoriasis rash, n(%)	12(100.0)(n=12)	39(90.7)(n=43)	0.566^▲

Items	Anti-CCP antibody positive group(n=7)	Anti-CCP antibody negative group(n=70)	P
Shoulder joint involvement, n(%)	5(71.4)	20(28.6)	0.059^#
Elbow joint involvement, n(%)	4(57.1)	14(20.0)	0.081^#
Wrist joint involvement, n(%)	6(85.7)	30(42.9)	0.077^#
MCP joint involvement, n(%)	6(85.7)	29(41.4)	0.065^#
PIP joint involvement, n(%)	7(100.0)	38(54.3)	0.053^#
DIP joint involvement, n(%)	3(42.9)	25(35.7)	1.000^#
Hip joint involvement, n(%)	1(14.3)	8(11.4)	1.000^▲
Knee joint involvement, n(%)	5(71.4)	42(60.0)	0.853^#
Ankle joint involvement, n(%)	2(28.6)	24(34.3)	1.000^#
MTP joint involvement, n(%)	3(42.9)	28(40.0)	1.000^#
PIP joint involvement of foot, n(%)	1(14.3)	15(21.4)	1.000^#
DIP joint involvement of foot, n(%)	0(0)	9(12.9)	0.590^▲
Spinal involvement, n(%)	1(14.3)	8(11.4)	1.000^▲
Sacroiliac joint involvement, n(%)	0(0)	14(20.0)	0.427^#
More than 3 articular regions involvement(14 articular regions), n(%)	7(100.0)	48(68.6)	0.188^#
Wrist, MCP or PIP(hand) joint involvement, n(%)	7(100.0)	54(77.1)	0.351^#
Symmetrical arthritis , n(%)	6(85.7)	40(57.1)	0.287^#
Oligoarthritis (4 or less joints involved), n(%)	0(0)	19(27.1)	0.259^#
Sausage fingers/toes, n(%)	2(28.6)(n=7)	21(31.3)(n=67)	1.000^#
Changes in nails, n(%)	2(50.0) (n=4)	16(31.4)(n=51)	0.833^#
Enthesitis, n(%)	0(0) (n=4)	17(33.3)(n=51)	0.408^#
Psoriasis rash, n(%)	4(100.0)(n=4)	47(92.2)(n=51)	1.000^▲