老年类风湿关节炎及其合并骨关节炎临床特点比较分析  

Comparative analysis of the clinical characteristics of elderly onset rheumatoid arthritis and elderly onset rheumatoid arthritis with osteoarthritis

作　　者：王洁[1] 房丽华[1] 刘晓萍[1] 李丽娜 崔潞萍[1] 张成强[1] 李瑞[1] 聂婷婷[1] Wang Jie;Fang Lihua;Liu Xiaoping;Li Lina;Cui Luping;Zhang Chengqiang;Li Rui;Nie Tingting(Department of Rheumatology and Immunology, Shanxi Provincial People's Hospital, Taiyuan 030012, China)

机构地区：[1]山西省人民医院风湿免疫科,太原030012

出　　处：《中华风湿病学杂志》2019年第9期593-598,共6页Chinese Journal of Rheumatology

基　　金：山西省留学办科学基金(2013-122);山西省卫生厅科技攻关项目(201201053).

摘　　要：目的比较老年类风湿关节炎(EORA)及其合并OA的临床表现、超声影像学表现和治疗效果评价。方法将88例发病年龄≥60岁的RA患者根据是否同时合并OA分为单纯EORA组(36例例)和EORA+OA组(52例),分析比较2组患者一般情况、关节受累分布、关节超声表现、治疗前后病情活动度评分。统计学方法采用χ^2检验/Fisher确切概率法或t检验、Mean-Whitney U检验。结果2组患者性别比及ESR比较差异无统计学意义(P>0.05);EORA+OA组患者发病年龄[(68±4)岁]大于单纯EORA组患者[(65±4)岁],差异有统计学意义(t=-3.465,P=0.001);EORA+OA组患者病程时间、BMI大于单纯EORA组患者。2组患者关节受累多见于肩、腕、掌指关节(MCP)2、MCP3、近端指间关节(PIP)2、PIP3、PIP4、膝关节(34.7%~86.5%)。EORA+OA组中同时出现RA和OA表现的关节与单纯EORA组出现RA表现的关节部位比较,MCP2[36.5%(38/104),70.8%(51/72);χ^2=20.02,P<0.01]、MCP3[33.7%(35/104),59.7%(43/72);χ^2=11.72,P=0.001]、MCP4[4.8%(5/104),22.2%(16/72);χ^2=12.28,P<0.01]、PIP2[69.2%(72/104),83.3%(60/72);χ^2=4.51,P=0.034]、PIP3[53.8%(56/104),70.8%(51/72);χ^2=5.15,P=0.023]百分比均低(P<0.05);MCP1、远端指间关节(DIP)2、DIP3、DIP4、膝关节百分比均高(P<0.05)。2组患者关节超声检查比较,EORA+OA组患者腕关节滑膜厚度[(4.2±0.5)mm]和膝关节滑膜厚度[(7.7±0.8)mm]较单纯EORA组患者均明显增厚[(3.2±0.9)mm;(6.3±0.8)mm,t=-5.82,P<0.01;t=-7.22,P<0.01];EORA+OA组患者腕关节滑膜血管翳血流2级+3级所占比例(70.0%)及膝关节滑膜血管翳血流2级+3级所占比例(70.9%)较单纯EORA组腕关节和膝关节滑膜血管翳血流2级+3级所占比例(51.9%;52.3%)均增大,2组比较差异均具有统计学意义(χ^2=4.64,P=0.031;χ^2=4.43,P=0.035)。2组患者入院时DAS28-3评分差异无统计学意义(P>0.05);糖皮质激素强化治疗2周和12周后,单纯EORA组DAS28-3评分[3.62(2.88,4.03)分;2.35(2.26,2.62)分]较EORA+OA组[5.01(4.68,5.26)分;3.38(Objective To compare the clinical features, ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA). Methods Eighty-eight patients with rheumatoid arthritis were divided into two groups: group EORA (n=36) and group EORA+OA (n=52). The onset age of all patients was 60 years or older. General conditions, joint involvement distribution, ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed. The χ^2 test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data. Results There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P>0.05). The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old], and the difference was statistically significant (t=-3.465, P=0.001). Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA. Joint involvement in the two groups was mainly found in shoulder, wrist, Metacarpophalangeal joint (MCP)2, MCP3, proximal inter-phalangeal joint (PIP)2, PIP3, PIP4, and knee joint (34.7%-86.5%). The percentage of MCP2[36.5%(38/104), 70.8%(51/72);χ^2=20.02, P<0.01], MCP3[33.7%(35/104), 59.7%(43/72);χ^2=11.72, P=0.001], MCP4[4.8%(5/104), 22.2%(16/72);χ^2=12.28, P<0.01], PIP2[69.2%(72/104), 83.3%(60/72);χ2=4.51, P=0.034] and PIP3[53.8%(56/104), 70.8%(51/72);χ^2=5.15, P=0.023] in the EORA+OA group was lower while the percentage of MCP1, DIP 2, DIP3, DIP4 and knee joints were higher than that in the EORA group (P<0.05). In group EORA+OA, the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm] were significantly thicker than those in group EORA [(3.2±0.9) mm;(6.3±0.8) mm, t=-5.82, P<0.01;t=-7.22, P<0.01];The proportion (70.0%) of level 2 and 3 of patients' wrist joint

关 键 词：老年人 关节炎 类风湿 骨关节炎 症状和体征 

分 类 号：R593.22[医药卫生—内科学]