摘要
目的IgG4在类风湿关节炎(RA)患者中的临床意义尚不明确。文中旨在探讨血清IgG4水平与类风湿关节炎疾病活动度的关系,分析其在RA共病(多系统受累)发生中的临床意义。方法纳入2013年9月-2017年5月在东部战区总医院确诊为RA患者123例,并按照性别、年龄1∶1匹配原则设定同期体检健康者及疾病对照组。比较3组患者IgG4水平。依据DAS28-CRP将RA患者分为缓解组、低活动度组、中活动度组、高活动度组,比较血清IgG4水平,评估IgG4高值RA患者实验室检查及临床特征,分析其与疾病活动指标之间的相关性。采用单因素分析和logistic回归法研究影响RA合并骨骼肌肉系统受累的危险因素。结果RA患者血清IgG4水平[480.0(257.0~965.0)mg/L]高于健康对照组[357.0(240.0~704.0)mg/L,P<0.05]及疾病对照组[330.0(167.0~624.0)mg/L,P<0.01];但RA患者不同疾病活动度组间IgG4水平差异无统计学意义(P>0.05);RA患者IgG4高值组(IgG4≥1832 mg/L)和IgG4水平正常组(IgG4<1832 mg/L)C3、C4、CRP、ESR、RDW、PLT、PLR、DAS28-CRP、RF、A-CCP差异均无统计学意义(P>0.05);相关分析结果显示,血清IgG4水平与C3、C4、CRP、ESR、RDW、PLT、PLR、DAS28-CRP、RF、A-CCP均无显著相关性(P均>0.05);RA合并骨骼肌肉系统疾病发生率为55.3%,合并组较不合并组患者具有年龄大,病程长,IgG4、IgE、RF、CRP、PLT、DAS28-CRP、循环系统及消化系统受累发生率高等特点(P<0.05);logistic回归分析结果显示,年龄≥55岁[OR=4.437,95%CI(1.723,11.424),P=0.002],病程≥72个月[OR=3.776,95%CI(1.384,10.305),P=0.009],IgG4≥1832 mg/L[OR=4.650,95%CI(1.064,20.317),P=0.041]是RA患者合并骨骼肌肉系统受累的危险因素。结论RA患者血清IgG4升高普遍存在,且IgG4升高是RA合并骨骼肌肉系统的危险因素;但与疾病活动无相关性。
Objective The clinical significance of IgG4 in patients with rheumatoid arthritis(RA)has not been fully understood.This study aims to investigate the relationship between serum IgG4 level and disease activity in patients with rheumatoid arthritis and analyze the significance of serum IgG4 in rheumatoid arthritis with multimorbidity(multi-system involvement).Methods A retrospective analysis was undertaken of 123 cases of RA patients diagnosed at the Eastern Theater General Hospital from September 2013 to May 2017.According to the gender and age 1∶1 matching principle,123 healthy persons and 123 disease control groups were matched and included.The IgG4 levels of the three groups were compared.According to the DAS28-CRP,RA patients were further divided into the remission group,low activity group,middle activity group,and high activity group,and the serum IgG4 levels were compared among those four groups.The laboratory examination parameters and clinical characteristics of RA with high IgG4 were further evaluated,also the correlation with disease activity was analyzed.The level of IgG4 in RA patients with comorbidity and the others was investigated.Single-factor analysis and binary logistic regression were used to analyze the risk factors of RA with musculoskeletal system involvement.Results The serum IgG4 level of RA patients(480.0[257.0-965.0]mg/L)was significantly higher than that of the healthy control group(357.0[240.0-704.0]mg/L)and the disease control group(330.0[167.0-624.0]mg/L);but there was no significant difference in IgG4 levels between RA patients with different disease activity;there was also no significant difference in C3,C4,CRP,ESR,RDW,PLT,PLR,A-CCP,RF,A-CCP between the high IgG4 group and the normal IgG4 group,either.The correlation analysis showed that there was no correlation between serum IgG4 level and C3,C4,CRP,ESR,RDW,PLT,PLR,DAS28-CRP,RF,A-CCP(P>0.05 for all).The incidence of RA combined with musculoskeletal system involvement was 55.3%.The age,duration,IgG4,IgE,RF,CRP,PLT,DAS28-CRP,the incidence of circulatory system involvement,and digestive system involvement were significantly higher in the combined group(n=68)than that in the not combined(n=55)(P<0.05 for all).Binary logistic regression analysis showed that the age over 55 years,duration over 72 months,and IgG4 over 1832 mg/L were risk factors of RA patients with musculoskeletal system involvement.Conclusion Raised serum IgG4 is common in RA patients,and elevated IgG4 is a risk factor for RA combined with the musculoskeletal system,but it has no correlation with disease activity.
作者
王子铭
周莹
李晓军
虞伟
WANG Zi-ming;ZHOU Ying;LI Xiao-jun;YU Wei(Department of Clinical Laboratory,Jinling Hospital Affiliated to Nanjing University Medical College/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Medical Laboratory,Taikang Xianlin Drum Tower Hospital Affiliated to Nanjing University Medical College,Nanjing 210000,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2020年第11期1161-1166,共6页
Journal of Medical Postgraduates
基金
国家自然科学基金(81071419)
江苏省科技支撑计划-社会发展项目(BE2011786)。
