原发性干燥综合征伴不同水平类风湿因子患者的免疫炎症特点研究

摘要： 背景 类风湿因子（RF）是原发性干燥综合征（pSS）患者中常见的自身抗体，其在疾病中的具体作用尚不完全明确。 目的 探索pSS伴不同水平RF患者的免疫炎症特点。 方法 采用调查研究的方法，纳入2018年12月-2022年9月于中日友好医院中医风湿病科就诊的262例pSS患者为研究对象。依据RF水平将患者分为3组：阴性组137例（RF<20 U/mL）、低滴度阳性组47例（RF：20~60 U/mL）、高滴度阳性组78例（RF>60 U/mL）。采集3组pSS患者的临床资料，包括一般资料、临床表现、症状评分、血液学指标，并比较组间差异。 结果 262例pSS患者RF阳性率为47.7%（125/262），其中男14例（5.3%）、女248例（94.7%），中位年龄57.0（49.0，63.0）岁，平均发病年龄（48.7±11.6）岁，中位病程60.0（24.0，120.0）个月；3组pSS患者性别、年龄、发病年龄、病程比较，差异均无统计学意义（P>0.05）。pSS患者常见临床表现前3位的依次为：口干257例、眼干247例、乏力235例；高滴度阳性组血液系统受累、关节炎发生率高于阴性组（P<0.05）；随着RF滴度的增加，pSS患者血液系统受累（χ2趋势=6.992，P趋势=0.008）、关节炎（χ2趋势=10.918，P趋势=0.001）发生率呈上升趋势。随着RF滴度的增加，pSS患者抗核抗体≥1∶160（χ2趋势=40.691，P趋势<0.001）、抗干燥综合征相关抗原A抗体阳性（χ2趋势=26.138，P趋势<0.001）、抗Ro52核糖核蛋白抗体阳性（χ2趋势=31.426，P趋势<0.001）、抗干燥综合征相关抗原B抗体阳性（χ2趋势=23.682，P趋势<0.001）、红细胞沉降率升高（χ2趋势=40.132，P趋势<0.001）、免疫球蛋白（Ig）A升高（χ2趋势=7.508，P趋势=0.006）、IgG升高（χ2趋势=71.570，P趋势<0.001）、补体3降低（χ2趋势=7.452，P趋势=0.006）、中性粒细胞计数降低（χ2趋势=8.364，P趋势=0.004）、血红蛋白降低（χ2趋势=6.390，P趋势=0.011）的发生率呈上升趋势。 结论 随着RF滴度升高，pSS患者血清免疫异常、腺体外受累的比例增加；RF滴度升高对关节炎、血液系统受累具有预测价值。

关键词: 干燥综合征, 类风湿因子, 免疫炎症, 关节炎, 调查和问卷, 北京市

Abstract:

Background

Rheumatoid factor (RF) is a common autoantibody found in patients with primary Sjögren's syndrome (pSS), but its specific role in the disease is not fully understood.

Objective

To explore the immune-inflammatory characteristics of pSS patients with different levels of RF.

Methods

This study included 262 pSS patients who visited the Department of Rheumatology of Traditional Chinese Medicine at China-Japan Friendship Hospital from December 2018 to September 2022. Patients were divided into three groups based on RF levels: negative group (RF<20 U/mL, n=137), low-titer positive group (RF: 20-60 U/mL, n=47), and high-titer positive group (RF>60 U/mL, n=78). Clinical data, including general information, clinical manifestations, symptom scores, and haematological indexes, were collected and compared among groups.

Results

The RF positivity rate in 262 pSS patients was 47.7% (125/262), including 14 males (5.3%) and 248 females (94.7%), with a median age of 57.0 (49.0, 63.0) years, an average age of onset of (48.7±11.6) years, and a median disease duration of 60.0 (24.0, 120.0) months. There were no significant differences in gender, age, age of onset, or disease duration among the three groups (P>0.05). The top three common clinical manifestations in pSS patients were dry mouth (257 cases), dry eyes (247 cases), and fatigue (235 cases). The incidence of haematological involvement and arthritis was higher in the high-titer positive group than in the negative group (P<0.05). With the increase in RF titer, the incidence of haematological involvement (χ2trend=6.992, Ptrend=0.008) and arthritis (χ2trend=10.918, Ptrend=0.001) showed an upward trend. As RF titer increased, the proportions of pSS patients with antinuclear antibody≥1∶160 (χ2trend=40.691, Ptrend<0.001), anti-SSA antibody positivity (χ2trend=26.138, Ptrend<0.001), anti-Ro52 antibody positivity (χ2trend=31.426, Ptrend<0.001), anti-SSB antibody positivity (χ2trend=23.682, Ptrend<0.001), elevated erythrocyte sedimentation rate (χ2trend=40.132, Ptrend<0.001), elevated immunoglobulin (Ig) A (χ2trend=7.508, Ptrend=0.006), elevated IgG (χ2trend=71.570, Ptrend<0.001), decreased complement 3 (χ2trend=7.452, Ptrend=0.006), decreased neutrophil count (χ2trend=8.364, Ptrend=0.004), and decreased hemoglobin (χ2trend=6.390, Ptrend=0.011) all showed an upward trend.

Conclusion

With the increase in RF titer, the proportion of pSS patients with serum immunological abnormalities and extra-glandular involvement increases. High RF titers have predictive value for arthritis and hematologic involvement.

Key words: Sj?gren's syndrome, Rheumatoid factor, Immune inflammation, Arthritis, Surveys and questionnaires, Beijing

中图分类号: R 593.2 

引用本文

杨建英,张燕,陈嘉琪,等. 原发性干燥综合征伴不同水平类风湿因子患者的免疫炎症特点研究[J]. 中国全科医学, 2025, 28(12): 1446-1452. DOI: 10.12114/j.issn.1007-9572.2024.0078.

YANG Jianying,ZHANG Yan,CHEN Jiaqi, et al. The Immune-inflammatory Characteristics of Primary Sjögren's Syndrome with Different Levels of Rheumatoid Factors[J]. Chinese General Practice, 2025, 28(12): 1446-1452. DOI: 10.12114/j.issn.1007-9572.2024.0078.

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