红细胞沉降率在系统性硬化病患者中的临床意义
Clinical significance of erythrocyte sedimentation rate levels in patients with systemic sclerosis
何慧琳 1周佳鑫 1侯勇 1徐东 1李梦涛 1曾小峰1
作者信息
- 1. 中国医学科学院 北京协和医学院 北京协和医院风湿免疫科 国家皮肤与免疫疾病临床医学研究中心 疑难重症及罕见病国家重点实验室 风湿免疫病学教育部重点实验室,北京 100730
- 折叠
摘要
目的 分析系统性硬化病(SSc)患者ESR水平和临床表现的关系,探讨ESR在SSc患者中的临床意义.方法 纳入2009年1月至2022年5月期间国家风湿病数据中心(CRDC)数据库中在北京协和医院注册登记的SSc患者.SSc符合1980年ACR制定的SSc诊断(分类)标准或2013年ACR/EULAR制定的SSc诊断(分类)标准,对其临床特征、实验室检查进行分析.计量资料符合正态分布或近似正态分布采用t检验.不符合正态分布以M(Q1,Q3)表示,采用秩和检验.计数资料以采用x2检验或Fisher精确检验,筛选出有统计学意义指标作为自变量进行二元logistic回归分析,P＜0.05为差异有统计学意义.结果 北京协和医院单中心共有308例SSc患者入组,其中女性280例(90.9％),平均年龄(47±12)岁.104例患者ESR升高.SSc合并ESR升高的患者合并肺间质病变(80.8％与67.6％,x2=5.89,P=0.015)、肺动脉高压(31.7％与 21.1％,x2=4.20,P=0.040)、肌炎(26.9％与 15.7％,x2=5.54,P=0.019)更常见.实验室检查中,SSc合并ESR升高的患者贫血更多见;CK、高敏CRP、IgA升高和IgG升高更多见,IgA、IgG数值更高;抗体检查中抗dsDNA抗体、抗核糖核蛋白抗体(抗RNP抗体)和抗干燥综合征抗原A抗体(抗SSA)、抗干燥综合征抗原B抗体(抗SSB抗体)阳性更多见,抗拓朴异构酶抗体(抗Scl70抗体)阳性更少见(P＜0.05).多因素回归分析结果提示 IgG 升高[B 值=1.733,OR值(95％CI)=5.657(2.839,11.272),P＜0.001]、贫血[B 值=1.083,OR值(95％CI)=2.952(1.376,6.333),P=0.005)]、抗 SSA 抗体阳性[B 值=1.665,OR值(95％CI)=5.287(2.367,11.809),P＜0.001]是 SSc合并ESR升高的独立相关因素,其中IgG升高和抗SSA抗体阳性是强相关因子.结论 SSc患者ESR升高更多见于合并贫血、IgG升高和抗SSA抗体阳性的患者,可能与疾病活动相关,对这类患者长期随访以观察预后有助于指导临床医生的治疗选择.
Abstract
Objective To analyze the relationship between the level of erythrocyte sedimentation rate(ESR)and clinical manifestations,and to discuss the clinical significance of ESR in patients with SSc.Methods Patients with SSc registered in Peking Union Medical College Hospital from January 2009 and May 2022 in the database of National Rheumatism Data Center(CRDC)were included.All patients fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism(ACR/EULAR)classification criteria for SSc.The clinical features and laboratory tests were analyzed.T test was used for analyzing the mea-surement data with normal distribution,and the results were expressed as mean±SD deviation.Wilcoxon signed-rank test or Wilcoxon rank sum test were used to analyze the measurement data that did not conform to normal distribution.The results were expressed as M(Q1,Q3).The count data were compared with Chisquare test or Fisher's exact test.Binary logistic regression analysiswas used to analyze independent variables.P val-ue＜0.05 was considered to be statistically significant.Results A total of 308 SSc patients were enrolled in the single center of Peking Union Medical College Hospital,including 280 females(90.9％),with the average age of(47±12)years old.SSc patients with elevated ESR combined woth anemia were more common.Compared with normal ESR group,elevated ESR group had higher incidence of pulmonary interstitial disease(80.8％vs.67.6％,x2=5.89,P=0.015),pulmonary hypertension(31.7％vs.21.1％,x2=4.20,P=0.040)and myositis(26.9％vs.15.7％,x2=5.54,P=0.019).In laboratory tests,anemia is highly frequent in SSc patients with increased ESR.The increase in CK,hs-CRP,IgA and IgG were more common,and the val-ues of IgA and IgG were sta-tistically higher.In antibody tests,anti-dsDNA antibody,anti-RNP antibody,anti-SSA and anti-SSB antibodies positivity were higher,and anti-Sc170 antibody positivity was less common(P＜0.05).Multivariate regression analysis indicated elevated IgG[B=1.733,OR(95％CI)=5.657(2.839,11.272),P＜0.001],anemia[B=1.083,OR(95％CI)=2.952(1.376,6.333),P=0.005)],positive anti-SSA antibody[B=1.665,OR(95％C1)=5.287(2.367,11.809),P＜0.001]were independent factors for SSc patients with elevated ESR are more common.IgG and positive anti-SSA antibody were strong risk factor for increased ESR.Conclusion SSc patients with elevated ESR are more commonl with anemia,elevated IgG and positive anti-SSA anti-body,which may be related to disease activity.Long-term follow-up for these patients is helpful to guide clini-cal doctors'treatment choices.
关键词
硬皮病,系统性/红细胞沉降率/合并症/危险因素Key words
Sclerosis,systemic/Erythrocyte sedimentation rate/Complication/Risk factor引用本文复制引用
基金项目
国家重点研发计划(2021YFC2501301-6)
北京市科学技术委员会资助项目(Z201100005520025)
中国医学科学院医学与健康科技创新工程(2021-12M/1-005)
出版年
2024
NETL
NSTL
万方数据