不同起病年龄与病程的类风湿关节炎患者临床特点分析  

Clinical characteristics of patients with rheumatoid arthritis of different ages and course of onset

作　　者：王鑫[1] 苏金虎 席海鹏 梁丽君[1] 王晓元[1] 沈海丽[1] Wang Xin Su Jinhu Xi Haipeng et al(Department of Rheumatology, Lanzhou University Second Hospital, Lanzhou 730000, Chin)

机构地区：[1]兰州大学第二医院风湿科,甘肃兰州730000 [2]兰州大学信息科学与工程学院 [3]原兰州军区机关医院

出　　处：《临床内科杂志》2017年第8期525-528,共4页Journal of Clinical Internal Medicine

基　　金：甘肃省兰州市科技计划项目（2015-2-56）

摘　　要：目的 探讨不同起病年龄与病程的类风湿性关节炎（RA）患者临床特点.方法 依据起病年龄和当前年龄,将120例RA分为老年起病RA（EORA,起病年龄≥60岁）组、非老年起病RA（NEORA,起病年龄＜60岁、当前年龄≥60岁）组和青年起病RA（YORA,起病年龄和当前年龄均＜ 60岁）组3组,每组各40例,对患者进行关节超声检查和疾病活动度评估并进行比较分析.结果 3组中EORA组女性、晨僵时间＞30 min患者比例最低,大关节起病、合并甲状腺功能异常和肿瘤标志物升高患者比例最高（P均＜0.05）;NEORA组患者病程最长,踝关节功能受限和腰骶关节受累患者比例最高,肩关节功能受限患者比例高于YORA组（P均＜0.05）;EORA组合并高血压、肺间质病变、贫血、慢性阻塞性肺疾病、皮疹患者比例均高于YORA组（P＜0.05）.YORA组、EORA组和NEORA组发生骨侵蚀的关节数量依次增多（P均＜0.05）.EORA组疾病活动性评分系统（DAS28）评分高于NEORA组（P＜0.05）.YORA组类风湿因子（RF）-IgM、抗环瓜氨酸肽（CCP）抗体、DAS28-红细胞沉降率（ESR）评分和DAS28-C反应蛋白（CRP）评分均与滑膜增生呈正相关（P＜0.01）;DAS28-ESR评分与彩色多普勒血流信号呈正相关（P＜0.05）.结论 以大关节起病的老年男性患者,需考虑RA的可能.采用超声检查评估青年起病RA患者的疾病活动度较老年RA患者更准确.EORA较同病程的YORA更易出现骨质破坏、合并多系统疾病.Objective To explore clinical characteristics of patients with rheumatoid arthritis （RA） of different ages and courses of onset.Methods According to ages of onset and present,120 patients were divided into elderly-onset RA （EORA,age of onset ≥ 60 years old） group,non-elderly-onset RA （NEORA,age of onset 〈 60 years old,age of present ≥60 years old）group and younger-onset RA （YORA,age of present 〈 60 years old）group with 40 patients in each group.Results of ultrasonography test of joint and assessment of disease activity were compared and analyzed.Results Ratios of patients with female and stiffness time 〉 30 minutes were the lowest,onset of large joints,thyroid dysfunction and elevated tumor markers in were the highest in EORA group among the three groups（P 〈 0.05）.In NEORA group,course of disease was the longest,ratios of patients with function limitation of ankle joint and sacroiliac joint involved were the highest,and function limitation of shoulder joint was higher than YORA group（P 〈0.05）.Ratios of patients with hypertension,pulmonary interstitial lesion,anemia,chronic obstructive pulmonary disease and erythra in EORA group were higher than those in YORA group（P 〈 0.05）.Number of joints with bone erosion in NEORA group was the highest,that in EORA group took the second place,and that in YORA group was the lowest（P 〈 0.05）.Disease activity scoring system（DAS28） scores in EORA group were higher than those in NEORA group （P 〈 0.05）.Rheumatoid factor （RF）-IgM,anti-cyclic citrullinated peptide antibody,DAS28-erythrocyte sedimentation rate and DAS28-C reactive protein scores were positively correlated with synovial hyperplasia （P 〈 0.01）.DAS28-ESR scores was positively correlated with color Doppler flow signal（P 〈 0.05）.Conclusion For elderly men suffered from large joints pain,RA should be considered.It is more exact to assess disease activity in YORA patients compared to elderly RA patients.Patients occur bone destruction and combine with

关 键 词：老年 类风湿性关节炎 疾病活动度 骨质破坏 

分 类 号：R259.932.2[医药卫生—中西医结合]