类风湿关节炎患者风湿病家族史特征及临床意义  

Family history of rheumatic diseases in patients with rheumatoid arthritis: a large scale cross-sectional study

作　　者：张晓英 靳家扬[1] 何菁 甘雨舟[1] 陈家丽 赵晓珍[1] 刘佳佳 尤旭杰 李雪 郭建萍[1] 李小峰[2] 李静[1] 李茹[1] 栗占国 ZHANG Xmo-ying;JIN jia-yang;HE Jing;GAN Yu-zhou;CHEN Jia-li;ZHAO Xiao-zhen;LIN Jia-jia;YOU Xu-jie;LI Xue;GUO Jian-ping;LI Xivo-feng;LI Jing;LI Ru;LI Zhan-guo(Department of Rheumatologa and Immunology,Peking University People's Hospital,Beijing Key Labootop for Rheumatism Mechanism and Immune Diagnosis!BZ0135),Beijing 100044,China;Department of Rheumatologa and Immunologa,Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]北京大学人民医院风湿免疫科,风湿病机制及免疫诊断北京市重点实验室(BZ0135),北京100044 [10]《北京大学学报(医学版)》 [11]Lancet Rheumatology [12]Annale of the Rheumatic Diseases [13]Nature Reviews Rheumatology [2]山西医科大学第二医院风湿免疫科,太原030001 [3]中国免疫学会临床免疫分会 [4]中华医学会风湿病学分会 [5]国际风湿病联盟和亚太风湿病联盟 [6]WHO骨关节肌肉疾病委员会 [7]Clinical Rheumatology [8]International Journal of Rheumatic Diseases [9]《中华风湿病学杂志》

出　　处：《北京大学学报（医学版）》2019年第3期439-444,共6页Journal of Peking University:Health Sciences

基　　金：西藏自治区自然科学基金项目(XZ2017ZR-ZYZ02);山西省青年科技研究基金面上项目(2015021180)~~

摘　　要：目的:分析类风湿关节炎(rheumatoid arthritis, RA)患者的风湿病家族史特征及其临床意义。方法:采用现场问卷调查方法,共调查890例RA患者,其中资料完整者803例,内容包括患者的性别、年龄、吸烟史、饮酒史、身高、体重、风湿病家族史、临床及血清学特征、疼痛和疾病总体评价、多维健康评估问卷等,并根据RA患者有无家族史进行分组比较。结果:本研究中,RA患者发病年龄为(45.09 ±14.50)岁,男女比例1 ∶ 3.5。有风湿病(包括RA、脊柱关节炎、干燥综合征、系统性红斑狼疮、系统性硬化症)家族史的患者123例(123/803, 15.32%),其中一级亲属患病者占有家族史者73.98%(91/123),二级亲属患病者占有家族史者17.89%(22/123),一级+二级亲属均患病10例(8.13%)。家族史疾病种类以RA为主,为70.73%(87/123),其他风湿性疾病为21.95%(27/123),RA合并其他风湿病占7.32%(9/123)。根据有无家族史,对两组RA患者的人口学特征和临床指标进行比较,结果显示:在有家族史患者中,发病年龄提前6.04年[( 39.97± 13.68)岁 vs.(46.01 ±14.46)岁],类风湿因子阳性率高(78.48% vs. 66.67%),差异具有统计学意义( P < 0.05)。校正性别、体重指数及抗环瓜氨酸肽抗体等混杂因素后,有家族史患者的发病年龄提前4.54年(β=-4.54;95% CI :-8.70,-0.38;P < 0.05)。进一步分层分析发现,在吸烟RA患者中,有家族史者发病年龄提前10.02年,差异具有统计学意义(β=-10.02;95% CI :-17.60 ,-2.43;P = 0.01);而在不吸烟RA患者中,有家族史者发病年龄提前3.27年,差异无统计学意义(β=-3.27;95% CI :-8.37, 1.82;P= 0.21)。结论:风湿病家族史是RA发病提前的危险因素,与吸烟可能具有协同作用。Objective: To determine the associations between the family history of rheumatic diseases and clinical features in patients with rheumatoid arthritis (RA). Methods: In total, eight hundred and ninety patients with RA were enrolled. The demographic and clinical data were collected, including gender, age, height, body weight, age of disease onset, history of smoking and drinking, family history of rheumatic diseases, clinical and laboratory features, pain and global visual analogue scale (VAS), and multi-dimensional health assessment questionnaire (MDHAQ). Finally, 803 patients were completed the dataset and were included in the study. Results: In this cohort, the male/female ratio was 1 ∶ 3.5 , and the age of onset was (45.09±14.50) years. A total of 123 (15.32%) patients were accompanied with family history of rheumatic diseases, including RA, spondyloarthritis, Sj gren’s syndrome, systemic lupus erythematosus and systemic sclerosis. The percentages of first degree, second degree and both first and second degree relatives were 91 (73.98%), 22 (17.89%), and 10(8.13%) respectively. The most common disease was RA (70.73%), followed by other rheumatic diseases ( 21.95%), and RA combined with other rheumatic diseases ( 7.32%). The clinical and laboratory characteristics were compared between the patients with and without family history. The onset-age of the subjects was significantly different between those with and without family history of rheumatic diseases (39.97 ±13.68 vs . 46.01± 14.46;P <0.01), which meant that the onset-age in patients with family history was 6.04 years earlier than that in patients without family history. The patients with family history had higher positive rate of rheumatoid factor (RF) compared with those without family history (78.48% vs . 66.67%, P < 0.05). By adjusting with gender, body mass index (BMI), smoking and alcohol drinking, anti- cyclic citrullinated peptide (CCP) antibody and RF level, the age at disease onset in the patients with family history was 4.54 years earlier t

关 键 词：类风湿关节炎 家族史 发病年龄 吸烟 

分 类 号：R593.22[医药卫生—内科学]