伴与不伴外周关节炎的中轴型脊柱关节炎临床特征及治疗的比较研究  

Clinical characteristics and treatment regimes of axial spondyloarthritis complicated with peripheral arthritis

作　　者：曾露露 冀肖健 胡立冬 胡嘉文 张奕楠 张家鑫 刘兴康 朱剑[2] 黄烽[2] ZENG Lulu;JI Xiaojian;HU Lidong;HU Jiawen;ZHANG Yi'nan;ZHANG Jiaxin;LIU Xingkang;ZHU Jian;HUANG Feng(Chinese PLA Medical School,Beijing 100853,China;Department of Rheumatology and Immunology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心风湿免疫科,北京100853

出　　处：《解放军医学院学报》2024年第2期146-151,188,共7页Academic Journal of Chinese PLA Medical School

摘　　要：背景尽管中轴型脊柱关节炎(axial spondyloarthritis,axSpA)是一种以中轴脊柱受累为主的慢性炎症性疾病,部分患者仍可能出现外周关节炎。国内外关于伴发外周关节炎的axSpA患者的临床特征和治疗选择研究较少,误诊误治常见。目的比较伴与不伴外周关节炎的axSpA患者在临床特征和治疗选择上的差异,为临床医师提供诊治依据。方法本研究为回顾性研究,连续纳入2016年1月—2022年12月于解放军总医院第一医学中心首次就诊的axSpA患者,根据患者是否伴随外周关节炎分为伴外周关节炎组和不伴外周关节炎组。采用倾向性评分匹配均衡就诊时间,对伴外周关节炎组和不伴外周关节炎组进行1∶3匹配,匹配后456例axSpA患者(伴外周关节炎组和不伴外周关节炎组分别为114例和342例)纳入分析,比较两组间临床特征和治疗选择差异。结果456例axSpA患者中,男性357例,女性99例,中位年龄30.0(IQR:25.0~36.5)岁。相比不伴外周关节炎的axSpA患者,伴外周关节炎的axSpA患者发病年龄较晚[M(IQR):23.0(18.6~31.7)岁vs 21.5(17.0~27.0)岁,P=0.022],病程较短[M(IQR):5.7(1.7~10.5)年vs 7.7(3.5~11.4)年,P=0.024],体质量指数较低[M(IQR):22.3(19.6~25.3)kg/m^(2) vs 23.6(20.7~25.8)kg/m^(2),P=0.01],吸烟比例较低[10.5%(12/114)vs28.4%(97/342),P<0.001],伴随更多的附着点炎和指/趾炎(P均<0.05)。此外,伴外周关节炎的axSpA患者的红细胞沉降率和C反应蛋白(C-reactive protein,CRP)水平更高(P均<0.05)。治疗方面,伴外周关节炎的axSpA患者更少地使用中成药[44.7%(51/114)vs 59.9%(205/342),P=0.005],更多地使用传统抗风湿药(conventional synthetic disease-modifying antirheumatic drugs,csDMARDs)[79.8%(91/114)vs 59.9%(205/342),P<0.001]、生物类药物(biologic disease-modifying antirheumatic drugs,bDMARDs)[40.4%(46/114)vs 21.3%(73/342),P<0.001]和糖皮质激素[9.6%(11/114)vs 0.6%(2/342),P<0.001],更多地联合使用传统和生物类抗风湿药物[30.7%(35/11Background Although axial spondyloarthritis(axSpA)is a chronic inflammatory disease primarily affecting the axial spine,some patients may also present with peripheral arthritis.There is limited research on the clinical characteristics and treatment options for axSpA patients with peripheral arthritis,both domestically and internationally,leading to frequent misdiagnosis and mistreatment.Objective To compare the clinical characteristics and treatment options between two groups of axSpA patients with or without peripheral arthritis,in order to assist clinicians in early detection and identification.Methods This was a retrospective study.axSpA patients who admitted to Chinese PLA General Hospital firstly from January 2016 to December 2022 were consecutively included.Patients were divided into the group with peripheral arthritis and the group without peripheral arthritis.A propensity score matching was performed to balance the baseline characteristics between the two groups using the visit time as a matching factor in a 1:3 ratio.After matching,456 patients with axSpA(114 with peripheral arthritis and 342 without peripheral arthritis)were included in the analysis.The clinical characteristics and differences in treatment choices between the two groups were compared.Results Of the 456 patients with axSpA,there were 357 males and 99 females with a median age of 30.0(IQR:25.0-36.5)years.Compared to axSpA patients without peripheral arthritis,axSpA patients with peripheral arthritis had a later onset of disease(M[IQR]:23.0[18.6-31.7]years vs 21.5[17.0-27.0]years,P=0.022),a shorter disease duration(M[IQR]:5.7[1.7-10.5]years vs 7.7[3.5-11.4]years,P=0.024),a lower body mass index(BMI)(M[IQR]:22.3[19.6-25.3]kg/m^(2) vs 23.6[20.7-25.8]kg/m^(2),P=0.01),a lower smoking rate(10.5%[12/114]vs 28.4%[97/342],P<0.001),and a higher prevalence of enthesitis and dactylitis(P<0.05 for both).Moreover,axSpA patients with peripheral arthritis had higher erythrocyte sedimentation rate and C-reactive protein(CRP)(P<0.05 for both).In terms of t

关 键 词：中轴型脊柱关节炎 强直性脊柱炎 外周关节炎 临床特征 药物治疗 

分 类 号：R593.2[医药卫生—内科学]