湿热痹阻与寒湿痹阻型类风湿关节炎相关细胞因子客观化研究

摘要

目的：探索类风湿关节炎（RA）湿热痹阻和寒湿痹阻型两型相关细胞因子、疾病活动指数等指标的差异，为类风湿关节炎湿热、寒湿痹阻两型辨证客观化提供临床依据。方法收集门诊及住院RA患者共80例，辨证分型为湿热痹阻与寒湿痹阻型。常规检测IL-1β、IL-2R、IL-6、IL-8、IL-10和TNF-α，及RF、ESR、CRP、抗环瓜氨酸肽抗体、25羟基维生素D等指标，疾病活动度以DAS28评分表示。探索两证型间各指标的差异，并进行ROC曲线分析及判别分析，建立判别函数公式。结果在类风湿关节炎湿热痹阻与寒湿痹阻两型患者中，IL-2R、IL-8、TNF-α和CRP在两证型间存在差异（P<0.05），ROC曲线图以湿热痹阻型为目标，结果显示：曲线下的面积由大到小依次为IL-2R>IL-8>TNF-α>CRP（P<0.05）；以上四项判别分析的判别函数，各研究对象回代后判别正确的概率是73.8%，交叉核实法表明判别正确的概率有72.5%。结论 IL-2R、IL-8、TNF-α与CRP可作为湿热痹阻与寒湿痹阻型RA客观化分型依据，其中以IL-2R与TNF-α更为显著。%Objective To explore the difference of some RA-related cytokines and other clinical indices of dampness-heat blockage syndrome and cold-dampness blockage syndrome. We try to find some objective indicator that may be helpful for the syndrome differentiation of RA. Methods Eighty cases of RA patients of the outpatient and inpatient department were enrolled in the study. The patients were divided into dampness-heat blockage syndrome and cold-dampness blockage syndrome according to syndrome differentiation. Blood test was conducted to detect IL-1β, IL-2R, IL-6, IL-8, IL-10, tumor necrosis factor α, rheumatoid factor; erythrocyte sedimentation rate, C-reactive protein, anti-cyclic citrullinated peptide antibodies and 25-hydroxy vitamin D. ROC curve analysis and discriminant analysis were done to find correlations between the various indicators and the differences between the two syndromes. And establish discriminant function formula. Results The IL-2R, IL-8, TNF-α and CRP have difference (P<0.05) between dampness-heat and cold-dampness blockage syndrome the two types of rheumatoid arthritis patients. The ROC graph for dampness-heat blockage syndrome as the goal shows the area under the curve of order was IL-2R> IL-8> TNF-α> CRP (P<0.05). For the discriminant function of the above four items discriminant analysis, the correct object back substitution probability is 73.8%, cross-verification method shows that the probability of correct identification was 72.5%. Conclusion The IL-2R, IL-8, TNF-α and CRP can be used as dampness-heat and cold-dampness blockage syndrome RA objective typing basis, and IL-2R and TNF-α are more significant than the other indicators.