类风湿关节炎患者吸烟与抗突变型瓜氨酸波形蛋白抗体及相关自身抗体疾病活动关系的研究  

The association among smoking, anti-modified citrullinated antibodies and some associated antibodies, disease activity in rheumatoid arthritis patients

作　　者：张露月[1] 茹晋丽[1] 颉晓香[1] 车国柱[1] 靳雪琴[1] 孙慧萍[1] 张译文[2] 李旭旭[1] 李小峰[3] 

机构地区：[1]中国人民解放军第264医院风湿免疫科,太原030001 [2]河南省中医院门诊部 [3]山西医科大学第二医院风湿免疫科

出　　处：《中华风湿病学杂志》2016年第4期253-256,共4页Chinese Journal of Rheumatology

摘　　要：目的探讨RA患者吸烟与抗突变型瓜氨酸波形蛋白（MCV）抗体及相关自身抗体、疾病活动的关系。方法收集632例RA患者临床及实验室资料，记录RA患者每日吸烟量、吸烟年限；采用ELISA法检测所有患者血清中的抗MCV抗体、抗CCP抗体，乳胶凝集法检测RF；应用t检验、方差分析、SNK．q检验及Spearman相关分析等进行统计学分析。结果抗MCV抗体滴度与DAS28评分、ESR、CRP、关节压痛数呈正相关（r=0．091，0．119，0．122，0．124，P〈0．05）；RF滴度与DAS28评分、ESR、CRP呈正相关（r=0．182，0．192，0．171，P〈0．05）。吸烟的RA患者抗MCV抗体、抗CCP抗体、RF的阳性率分别是不吸烟RA患者的1．631倍、1．489倍、1．350倍，三者95％CI分别为（0．721，3．690），（0．573，3．871），（0．781，2．334）。吸烟患者CRP值[（38±64）mg／L]高于不吸烟患者[（30±51）mg／L，t=-2．653，P〈0．05]。吸烟量10～19包年及≥20包年RA患者的CRP值[（73±76）mg／L，（39±63）mg／L]高于吸烟量为1～9包年的RA患者[（12±25）mg／L，P均〈0．05]。结论抗MCV抗体较抗CCP抗体、RF能更好地反映疾病活动。尚不能认为吸烟是抗MCV抗体、抗CCP抗体、RF的危险因素。CRP与吸烟量有关，余疾病活动指标与其无关。Objective To study the association between smoking, anti-modified citrullinated （MCV） antibodies and some associated antibodies, and disease activity. Methods Anti-cyclic citrullinated peptide （CCP） antibodies and anti-MCV antibodies were detected by enzyme-linked immunosorbent assay （ELISA）. RF was detected by latex agglutination test. The clinical and laboratory data of 632 patients with RA were collected. We kept a record of the daily smoking quantity, smoking years of RA patients. T test, analysis of variance （ANOVA） analysis, SNK-q test and Spearman correlation analysis were used for statistical analysis. Results Anti-MCV antibody level was positively related to disease activity score （DAS28）, erythrocyte sedimentation rate （ESR）, C reactive protein （CRP）, tender joint counts （r=0.091, 0.119, 0.122, 0.124, P〈0.05）. Rheumatoid factor （RF） level was positively related to DAS28, ESR and CRP （r=0.182, 0.192, 0.171, P〈0.05）. The positive rates of anti-MCV antibodies, anti-CCP antibodies and RF were 1.631 times, 1.489 times and 1.350 times higher in smokers than those of the non-smokers respectively. Their 95%CI were （0.721, 3.690）, （0.573, 3.871） and （0.781, 2.334） respectively. The CRP level of smokers [（38±64） mg/L] was higher than that of non-smokers [（30±51） mg//L, t=-2.653, P〈0.05]. They were not related to disease activity. The level of antibodies and disease activity were not changed with smoking quantity. The CRP level of patients who smoked 1 to 9 pack-years[（12±25） mg/L] was lower than those who smoked 10 to 19 pack-years and more than 20 pack-years patients [（73±76） mg/L,（39＋63） mg/L]（P〈0.05）. Conclusion Anti-MCV antibody is better than anti-CCP antibody and RF in reflecting disease activity. The CRP level of patients is corrected with smoking.No association is observed between disease activity and the quantity of smoking.

关 键 词：关节炎 类风湿 波形蛋白 吸烟 

分 类 号：R593.22[医药卫生—内科学]