类风湿性关节炎并发纳米细菌感染患者免疫水平及骨代谢变化  

Changes of immune function and bone metabolism in rheumatoid arthritis patients complicated with nanobacteria infection

作　　者：范先志 柯梅芳 郭大斌 FAN Xian-zhi;KE Mei-fang;GUO Da-bin(Longyou People's Hospital,Quzhou,Zhejiang 324400,China)

机构地区：[1]龙游县人民医院风湿科,浙江衢州324400 [2]龙游县人民医院重症监护室,浙江衢州324400

出　　处：《中华医院感染学杂志》2022年第11期1692-1696,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2014KYB311)。

摘　　要：目的研究类风湿性关节炎(RA)并发纳米细菌感染患者免疫水平及骨代谢变化。方法选取2018年1月-2021年1月龙游县人民医院风湿科收治的98例RA患者为研究对象,根据关节液培养结果分为A组(纳米细菌检出浓度≥3个/视野)22例、B组(纳米细菌检出浓度1~2个/视野)45例和对照组(未检出纳米细菌感染)31例,对三组患者的临床资料、血清细胞因子、免疫生化指标、骨代谢指标进行比较。结果A组患者的疾病活动性评分28(DAS28)高于B组,B组患者的DAS28高于对照组(P<0.05)。对照组、B组、A组患者的血清白细胞介素(IL)-1、肿瘤坏死因子(TNF)-α、C-反应蛋白(CRP)、免疫球蛋白(Ig)M、IgA、抗环瓜氨酸多肽抗体(anti-CCP)、类风湿因子(RF)、β-胶原降解产物(β-CTX)水平依次升高,骨密度(BMD)和血清总I型前胶原氨基端延长肽(tPINP)水平依次降低。以上组间差异均有统计学意义(P<0.05)。结论RA患者关节局部纳米细菌的感染和繁殖可加剧患者的全身免疫炎症损害和骨代谢紊乱,临床医生应给予高度的关注和及时的干预,从而达到缓解病情进展、保护关节和靶器官功能、改善生活质量和预后的目的。OBJECTIVE To study the effect of nanobacteria infection on immune function and bone metabolism in patients with rheumatoid arthritis(RA).METHODS A total of 98 patients with RA admitted to the Department of Rheumatology,Longyou people’s Hospital from Jan 2018 to Jan 2021 were selected as the research subjects.According to the results of joint fluid culture,they were divided into 22 cases of group A(detected concentration of nanobacteria≥3/field),45 cases of group B(detected concentration of nanobacteria was 1~2/field)and 31 cases of control group(excluded of nanobacteria infection).The clinical data,the serum cytokine,immune biochemical indicators and bone metabolism of the patients in the three groups were compared.RESULTS The disease activity score 28(DAS28)of patients in group A was significantly higher than that in group B,and DAS28 of patients in group B was significantly higher than that in the control group(P<0.05).The levels of serum interleukin(IL)-1,tumor necrosis factor(TNF)-α,C-reactive protein(CRP),immunoglobulin(Ig)M,IgA,anti-cyclic peptide containing citrulline(anti-CCP),rheumatoid factor,andβ-collagen degradation products of the patients in the control group,group B and group A increased sequentially,while the bone mineral density(BMD)and the serum total procollagenⅠN-terminal peptide(tPINP)level decreased in turn.The differences among the above groups were significant(P<0.05).CONCLUSION The infection and reproduction of local nanobacteria in the joints of RA patients can aggravate the systemic immune inflammation damages and bone metabolism disorders.Clinicians should pay close attention and timely intervention to alleviate disease progression,protect the function of joints and target organs,and improve life quality and prognosis.

关 键 词：纳米细菌 类风湿性关节炎 细胞因子 免疫生化指标 骨代谢指标 

分 类 号：R593.2[医药卫生—内科学]