类风湿关节炎患者223例共病现象的临床特征及其相关因素分析  

Clinical Features and Associated Factors of Rheumatoid Arthritis with Comorbidities in 223 Cases

作　　者：周珍妮 李芳[2] 黄德益 钱旭恒 王诗佳[3] 夏晓茹[4] 

机构地区：[1]浙江省乐清市人民医院内科,325600 [2]浙江省玉环县人民医院影像科,317600 [3]温州医科大学,浙江省温州市325000 [4]温州医科大学附属第一医院风湿免疫科,浙江省温州市325000

出　　处：《中国全科医学》2017年第18期2201-2207,共7页Chinese General Practice

摘　　要：目的探讨类风湿关节炎(RA)患者共病现象的临床特点及其相关影响因素,为全面评估患者预后及干预疾病提供临床依据。方法回顾性选取2013年1—12月在浙江省温州医科大学附属第一医院风湿免疫科诊治的符合纳入标准的223例RA患者的临床资料。记录患者一般资料和辅助检查结果,统计患者的共病情况,并分析RA共病现象与各指标的相关性及其影响因素。结果 223例RA患者中84.8%(189/223)存在共病现象,共发现16种,主要为高脂血症(41.3%,92/223)、高血压(40.8%,91/223)、骨质疏松症或骨量减少(以下简称骨松)(24.7%,55/223)、糖尿病(17.5%,39/223)、高尿酸血症(13.9%,31/223)、肾结石(13.5%,30/223)等。RA合并高脂血症与疾病活动指数(DAS28)评分(r_s=-0.146)、红细胞沉降率(ESR)(r_s=-0.153)、血压(r_s=0.194)、血尿酸(r_s=0.216)存在直线相关关系(P<0.05);RA合并高血压与年龄(r_s=0.353)、压痛关节数(TJC)(r_s=0.161)、肿胀关节数(SJC)(r_s=0.148)、血糖(r_s=0.290)、血脂(r_s=0.194)、血尿酸(r_s=0.220)、骨密度异常(r_s=0.202)存在直线相关关系(P<0.05);RA合并骨松与男性(r_s=-0.173)、年龄(r_s=0.362)、血压(r_s=0.202)存在直线相关关系(P<0.05);RA合并糖尿病与年龄(r_s=0.245)、TJC(r_s=0.145)、DAS28评分(r_s=0.182)、C反应蛋白(CRP)(r_s=0.195)、血压(r_s=0.290)存在直线相关关系(P<0.05);RA合并高尿酸血症与男性(r_s=0.141)、年龄(r_s=0.172)、血压(r_s=0.220)、血脂(r_s=0.216)存在直线相关关系(P<0.05);RA合并肾结石与CRP存在直线相关关系(r_s=0.135,P<0.05)。Logistic回归分析示,血压、血尿酸是RA合并高脂血症的危险因素(P<0.05);年龄、血糖、血脂、血尿酸是RA合并高血压的危险因素(P<0.05);女性、年龄为RA合并骨松的危险因素(P<0.05);RA病程、CRP、血压为RA合并糖尿病的危险因素(P<0.05);男性、血压、血脂为RA合并高尿酸血症的危险因素(P<0.05)。结论 RA患者易发生共病现象,以高�Objective To explore the clinical features and associated factors in rheumatoid arthritis（RA） patients with comorbidities,so as to provide a reference for comprehensively assessing the prognosis and delivering medical services for these patients.Methods The enrolled participants were 223 cases with RA diagnosed and treated in Department of Rheumatism and Immunology of the First Affiliated Hospital of Wenzhou Medical University between January and December 2013.We reviewed their clinical data,recorded their baseline characteristics（results of laboratory and imaging examinations）,status of comorbidities,and analyzed the associated factors of RA and the correlations between them.Results Comorbidities were found in 84.8%（189/233） of the participants,which mainly included 16 different diseases,such as hyperlipidemia （41.3%,92/233）,hypertension （40.8%,91/233）,osteoporosis or osteopenia（24.7%,55/233）,diabetes （17.5%,39/233）,hyperuricemia （13.9%,31/233）,urinary calculi （13.5%,30/233） and so on.Hyperlipidemia in RA had straight line correlation with Disease Activity Score 28（DAS28） （rs=-0.146,P〈0.05）,ESR （rs=-0.153,P〈0.05）,blood pressure （rs=0.194,P〈0.05）,serum uric acid （rs=0.216,P〈0.05）;hypertension in RA had straight line correlation with age （rs=0.353,P〈0.05）,TJC （rs=0.161,P〈0.05）,SJC （rs=0.148,P〈0.05）,fasting blood glucose （rs=0.290,P〈0.05）,blood lipid （rs=0.194,P〈0.05）,serum uric acid （rs=0.220,P〈0.05）,abnormal bone mineral density （rs=0.202,P〈0.05）;osteoporosis or osteopenia in RA had linear correlation with male （rs=-0.173,P〈0.05）,age （rs=0.362,P〈0.05）,blood pressure （rs=0.202,P〈0.05）;diabetes in RA had straight line correlation with age （rs=0.245,P〈0.05）,TJC （rs=0.145,P〈0.05）,DAS28 （rs=0.182,P〈0.05）,CRP （rs=0.195,P〈0.05）,blood pressure （rs=0.290,P〈0.05）;hyperuricemia in RA had straight line correlation with male（rs=0.141,P〈0.05）,age （rs=0.172,P〈0.05）

关 键 词：关节炎 类风湿 共病现象 影响因素分析 

分 类 号：R593.22[医药卫生—内科学]