寡关节炎型与对称性多关节炎型银屑病关节炎临床特征比较  

Comparison of clinical characteristics between oligoarthritis and symmetric polyarthritis of patients with psoriasis arthritis

作　　者：韦秀宁[1] 梁锦坚[1] 郑东辉[1] 莫颖倩[1] Wei Xiuning;Liang Jinjian;Zheng Donghui;Mo Yingqian(Department of Rheumatology and Immunology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院风湿免疫科,广州510120

出　　处：《中华风湿病学杂志》2024年第11期813-818,共6页Chinese Journal of Rheumatology

摘　　要：目的比较寡关节炎型与对称性多关节炎型银屑病关节炎(PsA)的临床特征,提高临床医生的认识。方法回顾性分析2003年2月至2018年5月中山大学孙逸仙纪念医院住院并符合Moll和Wright标准的PsA患者162例,参照PsA分类(CASPAR)标准对PsA进行临床分型,比较寡关节炎型与对称性多关节炎型PsA的临床特征及危险因素。比较高尿酸血症与正常尿酸水平PsA的临床特征。符合正态分布的计量资料2组间比较采用t检验;呈偏态分布的计量资料2组间比较采用Mann-Whitney U检验。结果162例PsA患者,平均起病年龄(38±15)岁,平均病程(7.3±6.6)年,男性比例72.8%(118/162)。对称性多关节炎型89例(54.9%),寡关节炎型49例(30.2%)。寡关节炎型患者病程显著短于对称性多关节炎型[4.0(0.8,8.5)年与7.0(2.0,10.0)年,Z=-2.83,P=0.005]。寡关节炎型患者的平均血尿酸水平[(391±126)μmol/L与(334±130)μmol/L,t=2.00,P=0.016]及合并高尿酸血症的比例[44.9%(22/49)与23.6%(21/89),χ^(2)=6.68,P=0.010]显著高于对称性多关节炎型患者。多因素logistic回归分析示:合并高尿酸血症的患者表现为寡关节炎型PsA的风险显著升高[OR值(95%CI)=2.938(1.252,6.890),P=0.013]。伴有高尿酸血症的PsA患者与正常尿酸水平的患者相比,平均年龄更大[(51±13)岁与(48±16)岁,t=-3.30,P=0.001],男性比例更多[86.0%(37/45)与55.6%(45/81),χ^(2)=11.66,P=0.001],中位银屑病皮疹病程更长[11.0(6.0,11.5)年与8.5(8.0,18.0)年,χ^(2)=2.10,P=0.036],寡关节炎型比例更高[51.2%(22/43)与28.4%(23/81),χ^(2)=6.30,P=0.012],合并高血压[20.9%(9/43)与7.4%(6/81),χ^(2)=4.83,P=0.028]、心血管疾病[9.3%(4/43)与1.2%(1/81),χ^(2)=2.87,P=0.049]的比例更高,差异均有统计学意义(均P<0.05)。结论寡关节炎型PsA较对称性多关节炎型PsA患者病程更短,血尿酸水平及高尿酸血症比例更高;伴有高尿酸血症的PsA患者更多表现为寡关节炎型,合并高血压、心血管疾病的风险更高。Objective To analyze the clinical characteristics of psoriatic arthritis(PsA)and to raise clinicians′awareness.Methods We retrospectively analyzed the clinical characteristics of hospitalized patients with the diagnosis of PsA in our hospital.The PsA were classified according to the Classification of Psoriatic Arthritis(CASPAR)criteria.We compared the clinical characteristics and risk factors between the oligoarthritis type and symmetrical polyarthritis subtypes.Comparing the clinical features of PsA patients with hyperuricemia to those with normal uric acid levels.The t-test was utilized to assess the differences in normally distributed continuous variables between the two groups,while the Mann-Whitney U test was employed for the comparison of skewed distributed continuous variables across the groups.Results 162 PsA patients were included,the average age at PsA onset was(38±15)years old and the average of PsA duration was(7.3±6.6)years,72.8%(118/162)patients were male.Eighty-nine patients(54.9%)presented with symmetric polyarthritis,and 49 patients(30.2%)with oligoarthritis.The median duration of PsA in patients with oligoarthritis was significantly shorter than patients with symmetric polyarthritis[4.0(0.8,8.5)years vs.7.0(2.010.0)years,Z=-2.83,P=0.005].Mean serum uric acid levels[(391±126)μmol/L vs.(334±130)μmol/L,t=2.00,P=0.016]and the proportion of patients with concomitant hyperuricemia[(44.9%(22/49)vs.23.6%(21/89),χ^(2)=6.68,P=0.010]in patients with oligoarthritis was significantly higher than that of patients with symmetric polyarthritis.Multivariate logistic regression analysis showed that patients with hyperuricemia had a significantly increased risk of presenting with oligoarthritis subtype of PsA[OR(95%CI)=2.938(1.252,6.890),P=0.013].Compared with patients with normal uric acid,PsA patients with hyperuricemia were older in age[(51±13)years vs.(48±16)years,t=-3.30,P=0.001],and had a higher proportion of males[86.0%(37/45)vs.55.6%(45/81),χ^(2)=11.66,P=0.001]longer median duration of psoriasi

关 键 词：银屑病关节炎 尿酸 高尿酸血症 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]