老年发病类风湿关节炎的临床特征及其心血管疾病危险因素分析:一项大样本横断面临床研究  

Clinical characteristics and risk factors of cardiovascular disease in patients with elderly-onset rheumatoid arthritis:A large cross-sectional clinical study

作　　者：陈家丽[1] 金月波[1] 王一帆 张晓盈[1] 李静[1] 姚海红[1] 何菁[1] 李春[1] CHEN Jia-li;JIN Yue-bo;WANG Yi-fan;ZHANG Xiao-ying;LI Jing;YAO Hai-hong;HE Jing;LI Chun(Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China)

机构地区：[1]北京大学人民医院风湿免疫科,北京100044

出　　处：《北京大学学报（医学版）》2020年第6期1040-1047,共8页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81701598、81801618);北京市自然科学基金(7192211)。

摘　　要：目的:了解我国老年发病类风湿关节炎(elderly-onset rheumatoid arthritis,EORA)患者的临床特点及其心血管疾病(cardiovascular disease,CVD)发生的危险因素。方法:收集2009年7月至2014年12月于北京大学人民医院就诊的1116例类风湿关节炎(rheumatoid arthritis,RA)患者的临床资料及CVD(缺血性心脏病、脑及外周血管病)患病情况。根据发病年龄≥60岁和<60岁,分为EORA组(212例)和青壮年发病RA组(younger-onset RA,YORA,904例),采用Student’s t检验、非参数U检验、χ^2检验比较两组间差异,并通过Logistic回归分析EORA合并CVD的危险因素。结果:EORA和YORA两组的疾病活动度差异无统计学意义。EORA组男性患者比例、肺间质病变比例、畸形关节数显著高于YORA组[(32.1%vs.18.5%,χ^2=19.11,P<0.001;23.6%vs.13.6%,χ^2=16.50,P<0.001;6(2,12)vs.3(2,7),Z=-3.60,P<0.001)],而合并干燥综合征的比例低于YORA组(13.5%vs.5.2%,χ^2=11.29,P=0.001)。EORA组未用改善病情的抗风湿药(disease-modifying antirheumatic drugs,DMARDs)的比例高于YORA组(35.4%vs.26.7%,χ^2=6.43,P=0.011),羟氯喹(hydroxychloroquine,HCQ)、甲氨蝶呤(methotrexate,MTX)及柳氮磺吡啶(sulfasalazine,SSZ)的使用率显著低于YORA组。EORA组CVD发生率显著高于YORA组(27.8%vs.11.6%,χ^2=40.46,P<0.001),传统心血管危险因素中的吸烟、高血压及高脂血症比例也更高。多因素Logistic回归分析表明,高龄(OR=1.10,95%CI:1.00~1.20)、畸形关节数(OR=3.17,95%CI:1.04~9.68)、类风湿结节(OR=3.56,95%CI:1.03~12.23)、高血压(OR=2.37,95%CI:1.09~5.13)、高脂血症(OR=8.85,95%CI:2.50~31.27)是CVD的危险因素,使用HCQ(OR=0.22,95%CI:0.07~0.70)和MTX(OR=0.32,95%CI:0.14~0.73)是CVD的保护因素。结论:与YORA相比,EORA中男性及肺间质病变的患者更多,易出现关节畸形,可能与治疗欠规范有关。EORA易合并CVD,高龄、畸形关节数、类风湿结节、高血压、高脂血症是危险因素,而HCQ和MTX的使用是保护因素。Objective:To investigate the clinical characteristics of patients with elderly-onset rheumatoid arthritis(EORA),and the risk factors of EORA complicated with cardiovascular disease(CVD).Methods:A cross-sectional study was conducted in Peking University People’s Hospital from July 2009 to December 2014 and 1116 patients were recruited.The patients’characteristics and CVD,including ischemic heart disease,cerebral and peripheral vascular disease,were recorded.The patients were divided into EORA group(n=212)and younger-onset rheumatoid arthritis(YORA)group(n=904)according to the age of onset≥60 years and<60 years.Then,the differences between the groups were analyzed by Student’s t test,Mann-Whitney U test orχ^2test,and risk influencing CVD were analyzed using Logistic regression.Results:There was no significant difference in the disease activity between the EORA and YORA groups.The proportion of male,pulmonary interstitial disease(ILD),and numbers of deformity joint count(DJC)were significantly higher in the EORA group compared with the YORA group[32.1%vs.18.5%,χ^2=19.11,P<0.001;23.6%vs.13.6%,χ^2=16.50,P<0.001;6(2,12)vs.3(2,7),Z=-3.60,P<0.001],while the prevalence of Sjögren’s syndrome was lower than that of the YORA group(13.5%vs.5.2%,χ^2=11.29,P=0.001).Moreover,there were lower prevalences in the patients treated with disease-modifying antirheumatic drugs(DMARDs)in EORA group(35.4%)than in YORA group(26.7%)(χ^2=6.43,P=0.011),especially in methotrexate(MTX),hydroxychloroquine(HCQ)and sulfasalazine(SSZ).In addition,the patients with EORA had a higher prevalence of CVD(27.8%)than the YORA group(11.6%,χ^2=40.46,P<0.001),accompanied with higher prevalence of smoking,hypertension,and hyperlipidemia.Multivariate Logistic regression analysis showed that elder age(OR=1.10,95%CI:1.00-1.20),DJC(OR=3.17,95%CI:1.04-9.68),rheumatoid nodules(OR=3.56,95%CI:1.03-12.23),hypertension(OR=2.37,95%CI:1.09-5.13)and hyperlipidemia(OR=8.85,95%CI:2.50-31.27)were independent risk factors,while HCQ(OR=0.22,95%CI:0.07-0.70)and

关 键 词：类风湿关节炎 老年人 心血管疾病 危险因素 

分 类 号：R593.22[医药卫生—内科学]