Title风湿免疫病相关冷球蛋白血症33例临床及免疫学特征分析
Other TitlesClinical and laboratory features of rheumatic autoimmune disease associated cryoglobulinaemia
Authors温雯
李春
贾汝琳
栗占国
Affiliation100044,北京大学人民医院风湿免疫科 风湿病机制及免疫诊断北京市重点实验室 BZ0135
Keywords冷球蛋白血症
自身免疫病
红斑狼疮,系统性
干燥综合征
Cryoglobulinemia
Autoimmune disease
Lupus erythematosus,systemic
Sj ?grenˊs syndrome
Issue Date2016
Publisher中华风湿病学杂志
Citation中华风湿病学杂志.2016,(2),100-105.
Abstract目的:研究自身免疫病相关冷球蛋白血症患者的临床及实验室特征。方法回顾性分析2010年4月至2014年5月间于北京大学人民医院行冷球蛋白检测阳性的33例自身免疫病患者的临床及实验室资料。采用t检验,Mann-Whitney U检验,Fisher精确检验或χ2检验。结果33例合并冷球蛋白血症患者年龄12~75岁,平均(47±17)岁,其中女性26例,男性7例,诊断依次为SLE、SS、PM/DM、RA、SSc、ANCA相关性血管炎、抗磷脂综合征、PBC。 SLE及SS合并冷球蛋白血症者占总例数的85%(28/33)。SLE患者出现冷球蛋白阳性的时间为2.0(1.0,12.0)年,冷球蛋白阳性患者比阴性患者肾脏受累(71%与40%,χ2=15.372,P=0.004)、抗RNP抗体(56%与20%,χ2=7.405,P=0.007)、心磷脂抗体(53%与8%,χ2=12.356,P<0.01)更为常见。 SS患者出现冷球蛋白血症的时间为11.0(4.0,18.0)年,冷球蛋白阳性患者的RF[1170.00(230.00,2800.00) U/ml, U=-0.002,P=0.001]、IgM水平[3.54(1.83,4.34) g/L, U=0.016, P=0.014]明显高于冷球蛋白阴性者[57.80(20.00,230.50) U/ml,1.17(0.81,2.26) g/L],补体 C3[0.58(0.33,0.68) g/L,U=0.004,P=0.003]、补体C4[0.06(0.03,0.12) g/L,U=0.017,P=0.016]水平显著低于冷球蛋白阴性患者0.81(0.67,0.98) g/L,0.16(0.12,0.22) g/L。结论自身免疫病合并冷球蛋白血症以SLE和SS最多。心磷脂抗体、抗RNP抗体等自身抗体,与合并冷球蛋白血症的发生呈正相关。合并冷球蛋白血症的SLE患者肾脏受累更为常见。
Objective To investigate the clinical and laboratory features of autoimmune disease (AID) associated cryoglobulinaemia. Methods From April 2010 to May 2014, thirty threc patients with AID in Peking University Peopleˊs Hospital were tested positive for cryoglobulin. Their clinical and laboratory features were analyzed retrospectively. T test, Mann-Whitney U test, Chi-squaretest and Fisherˊs exact test were used for statistical analysis. Results Among the 33 patients, 26 were female, 7 were male, the average age was (47 ± 17) years old (range 12-75 years old). The spectrum of autoimmune diseases included, in order, systemic lupus erythematosus (SLE), Sj?grenˊs syndrome (SS), multiple myositis/dermatomyositis, rheumatoid arthritis (RA), systemic sclerosis (SSc), anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, antiphospholipid syndrome and primary biliary cirrhosis. SLE and SS accounted for 84.8% (28/33) in tpatients with cryoglobulinaemia. In patients withSLE, cryoglobulinaemia occurred at 2.0 (1.0-12.0) years after disease onset, and cryoglobulinpositive patients had more frequent renal involvement (71% vs 40%, P=0.004), positive anti-RNP (56% vs21%, P=0.007) and ACL (53% vs 8%, P=0.000). However, among patients with SS, cryoglo-bulinaemia occurred at 11.0 (4.0-18.0) years after disease onset, and cryoglobulin positive patients had higher rheumatoid factors (RF) [1 170 (230.00, 2 800.00) U/ml vs 57.80 (20.00, 230.50) U/ml, U=-0.002, P=0.001], IgM [3.54 (1.83, 4.34) g/L vs 1.17 (0.81, 2.26) g/L , U=0.016, P=0.014] and lower complement C3 [0.58 (0.33, 0.68) g/L vs 0.81 (0.67, 0.98 g/L), U=0.004, P=0.003] and C4 [0.06 (0.03, 0.12) g/L vs 0.16 (0.12, 0.22), U=0.017, P=0.016]. Conclusion Autoimmune disease complicated with cryoglo-bulinaemia is not uncommon in clinical practice, in which SLE and SS account for the leading two causes. Patients with positive anti-RNP and/or ACL are positively associated with cryoglobulinaemia. renal involvement of SLE is increased by the presence of cryoglobulin.
URIhttp://hdl.handle.net/20.500.11897/441449
ISSN1007-7480
DOI10.3760/cma.j.issn.1007-7480.2016.02.006
Indexed中文核心期刊要目总览(PKU)
中国科技核心期刊(ISTIC)
中国科学引文数据库(CSCD)
Appears in Collections:人民医院

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