老年类风湿关节炎并肺间质病变的血清指标分析

Analysis on serum indicators in elderly rheumatoid arthritis patients complicated with interstitial lung disease

【摘要】目的 分析老年类风湿关节炎(RA)合并肺间质病变(ILD)患者血清抗环瓜氨酸肽(CCP)抗体、白细胞介素22(IL-22)及骨桥蛋白(OPN)水平变化及其临床意义。方法 收集天津医科大学第二医院收治的136例RA老年患者临床资料,根据是否发生ILD,分为ILD组(n=35例)与非ILD组(n=101例)。比较两组患者血清抗CCP抗体、IL-22及OPN水平。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。采用受试者工作特征(ROC)曲线评估血清抗CCP抗体、IL-22及OPN诊断RA合并ILD的最佳截断点,并采用logistic回归分析评估RA合并ILD的危险因素。结果 ILD组年龄及血清抗CCP抗体、IL-22、OPN水平均显著高于非ILD组,差异有统计学意义(P＜0.05)。ROC曲线分析结果显示,血清抗CCP抗体、IL-22、OPN诊断RA合并ILD差异有统计学意义(P＜0.05)；其最佳截断点分别为53.36U/ml、75.68pg/ml、15.30ng/ml。logistic回归分析结果显示,年龄＞70岁(OR=1.766,95%CI 1.024~3.116)、抗CCP抗体＞53.36U/ml(OR=3.536,95%CI 1.921~6.510)、IL-22＞75.68pg/ml(OR=4.721,95%CI 2.899~7.687)、OPN＞15.30ng/ml(OR=5.658,95%CI 3.606~8.876)均为RA合并ILD的危险因素(P＜0.05)。结论 抗CCP抗体、IL-22及OPN可能参与RA合并ILD的发生机制,年龄更高的老年RA患者合并ILD风险更高,可为临床诊疗及防控工作提供一定指导。

基金项目:天津市教委科研计划项目(2020KJ175)

【Abstract】Objective To analyze the changes and clinical significance of serum anti-cyclic citrullinated peptide (CCP) antibody, interleukin-22 (IL-22) and osteopontin (OPN) levels in elderly patients with rheumatoid arthritis (RA) complicated with interstitial lung disease (ILD). Methods The clinical data of 136 elderly RA patients treated in our hospital were collected, and based on the presence of ILD or not, the patients were divided into ILD group (35 cases) and non-ILD group (101 cases). Serum levels of anti-CCP antibody, IL-22 and OPN were compared between the two groups of patients. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was performed using t test or χ² test depending on data type. The cut-off values of above three indicators in the diagnosis of RA with ILD were evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was adopted to identify the risk factors of RA with ILD. Results Significantly advanced age and higher serum levels of anti-CCP antibody, IL-22 and OPN were observed in the ILD group than the non-ILD group (P<0.05). ROC curve analysis showed that there were statistical significance in the three indicators in the diagnosis of RA with ILD (P<0.05), and their cutoff values were 53.36 U/ml, 75.68 pg/ml and 15.30 ng/ml respectively. Logistic regression analysis indicated that age >70 years (OR=1.766,95%CI 1.024-3.116), anti-CCP antibody >53.36 U/ml (OR=3.536,95%CI 1.921-6.510), IL-22 >75.68 pg/ml (OR=4.721,95%CI 2.899-7.687) and OPN >15.30 ng/ml (OR=5.658,95%CI 3.606-8.8765) were risk factors for RA with ILD (P<0.05). Conclusion Anti-CCP antibody, IL-22 and OPN may be involved in the pathogenesis of RA with ILD. The elderly RA patients with older age have higher risk of ILD, which can provide some guidance for clinical diagnosis and treatment, as well as prevention and control.

This work was supported by the Project of Scientific Research Plan of Tianjin Education Commission (2020KJ175).