来源：风湿病与关节炎,2020,9（8）:7-11.

类风湿关节炎活动期患者脂蛋白代谢变化及相关性分析

（临床研究）

贺明玉¹，刘　健²，忻　凌²，韩馨悦¹，孙艳秋¹，张　颖¹

　　【摘　要】目的：研究类风湿关节炎患者脂蛋白代谢指标的变化，分析其与类风湿关节炎标志物、免疫、炎症等指标的关系。方法：选取安徽中医药大学第一附属医院风湿病科1542例类风湿关节炎住院患者的病例资料，采用SPSS Clementine 17.0统计软件，运用关联规则分析、相关性分析、Logistic回归分析等方法进行数据挖掘分析。结果：①1542例类风湿关节炎患者脂蛋白代谢指标值分析显示：高密度脂蛋白胆固醇（HDL-C）下降256例（16.60%），低密度脂蛋白胆固醇（LDL-C）上升281例（18.22%），载脂蛋白-A1（APO-A1）下降361例（23.41%），载脂蛋白-B（APO-B）上升256例（16.60%）。②相关性分析显示：HDL-C与类风湿因子（RF）、抗链球菌溶血素“O”（ASO）、红细胞沉降率（ESR）、超敏C-反应蛋白（hs-CRP）、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、补体C3、补体C4呈负相关，与葡萄糖-6-磷酸异构酶（GPI）呈正相关；APO-B与ASO、免疫球蛋白M（IgM）、IgG呈负相关，与ESR、hs-CRP、补体C3、补体C4呈正相关；APO-A1与RF、GPI、ASO、ESR、抗环瓜氨酸肽抗体（抗CCP抗体）、hs-CRP、IgA、IgG、补体C3呈负相关；LDL-C与ASO、hs-CRP、IgA、IgM、IgG呈负相关，与补体C3、补体C4呈正相关。③Logistic回归分析显示：ESR、hs-CRP、补体C3是LDL-C升高的危险因素，RF、ESR、hs-CRP、IgA、补体C4是HDL-C降低的危险因素，hs-CRP、补体C4是APO-A1降低的危险因素，补体C3是APO-B升高的危险因素。④关联结果分析显示：设定最小置信度为80%，最小支持度为25%。提取与APO-A1下降关联较高的指标分别是抗CCP抗体、ESR、RF、hs-CRP；与APO-B上升关联较高的指标分别是抗CCP抗体、ESR、RF，其提升度均 > 1。结论：类风湿关节炎患者存在脂蛋白代谢紊乱，主要表现为HDL-C、APO-A1降低，LDL-C、APO-B升高，炎症反应和免疫功能紊乱是类风湿关节炎脂蛋白代谢紊乱的危险因素。

　　【关键词】　关节炎，类风湿；载脂蛋白；脂蛋白代谢；活动期；相关性分析

Changes and Correlation Analysis of Lipoprotein Metabolism in Patients with Active Rheumatoid Arthritis

HE Ming-yu,LIU Jian,XIN Ling,HAN Xin-yue,SUN Yan-qiu,ZHANG Ying

　　【ABSTRACT】Objective:To study the changes of lipoprotein metabolism in patients with rheumatoid arthritis（RA）,and analyze the relationship between lipoprotein metabolism and markers of RA,immunity and inflammation indexes.Methods:The data of 1542 patients with rheumatoid arthritis treated in the First Affiliated Hospital of Anhui University of Chinese Medicine were selected.Software SPSS Clementine 17.0 was used for data mining analysis by association rule analysis,correlation analysis and logistic regression analysis.Results:①In 1542 patients with rheumatoid arthritis,HDL-C decreased in 256 cases（16.60%）,LDL-C increased in 281 cases（18.22%）,APO-A1 decreased in 361 cases（23.41%）,and APO-B increased in 256 cases（16.60%）.②Correlation analysis showed that HDL-C was negatively correlated with RF,ASO,ESR,hs-CRP,IGA,IgG,C3 and C4,and positively correlated with GPI;APO-B was negatively correlated with ASO,IgM and IgG and positively correlated with ESR,hs-CRP,C3 and C4;APO-A1 was negatively correlated with RF,GPI,ASO,ESR,anti-CCP-antibody,hs-CRP,IgA,IgG and C3;LDL-C was negatively correlated with ASO,hs-CRP,IgA,IgM and IgG,and positively correlated with C3 and C4.③Logistic regression analysis showed that ESR,hs-CRP and C3 were the risk factors for the increase of LDL-C;RF,ESR,hs-CRP,IgA and C4 were the risk factors for the decrease of HDL-C;hs-CRP and C4 were the risk factors for the decrease of APO-A1;C3 was the risk factor for the increase of APO-B.④The analysis of the correlation results showed that the minimum confidence level was 80% and the minimum support was 25%.Anti-CCP-antibody,ESR,RF and hs-CRP were highly correlated with the decrease of APO-A1,while the indexes with high correlation with the rise of APO-B were anti CCP antibody,ESR and RF,with the increase degree above 1.Conclusion:There is a disorder of lipoprotein metabolism in patients with rheumatoid arthritis,mainly manifested as the decrease of HDL-C and APO-A1,the increase of LDL-C and APO-B.The disorder of inflammatory reaction and immune function is the risk factor of lipoprotein metabolism disorder in rheumatoid arthritis.

　　【Keywords】 arthritis,rheumatoid;apolipoprotein;lipoprotein metabolism;active phase;correlation analysis