低疾病活动度的中轴型脊柱关节炎患者残留症状评估及其相关因素分析  

Assessment of residual symptoms in patients with axial spondyloarthritis with low disease activity and analysis of its related factors

作　　者：翟佳羽[1] 赵金霞[1] 安卓[1] 刘蕊[1] ZHAI Jiayu;ZHAO Jinxia;AN Zhuo;LIU Rui(Department of Rheumatology and Immunology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院风湿免疫科,北京100191

出　　处：《北京大学学报（医学版）》2024年第6期987-993,共7页Journal of Peking University:Health Sciences

摘　　要：目的:评估达到低疾病活动度(low disease activity,LDA)的中轴型脊柱关节炎(axial spondyloarthritis,ax-SpA)患者的残留症状发生情况,并对相关因素进行分析。方法:对2021年5月1日至2024年2月29日于北京大学第三医院风湿免疫科就诊的首次达到LDA的ax-SpA患者的病例资料进行分析,根据强直性脊柱炎疾病活动评分-C反应蛋白(ankylosing spondylitis disease activity score-C-reactive protein,ASDAS-CRP),将达到LDA的患者分为达到LDA但未缓解组和缓解组,评估两组患者残留疲劳及疼痛症状的发生情况,并采用二元Logistic回归分析其相关因素。结果:在治疗过程中首次达到LDA的患者201例,包括男性151例(75.1%)、女性50例(24.9%),中位年龄32.0(28.0,37.0)岁,中位病程6.7(3.8,11.5)年,其中达到LDA但未缓解组140例(69.7%)、缓解组61例(30.3%)。残留疲劳视觉模拟评分(visual analogue scale,VAS)≥4分患者92例(45.8%),其中达到LDA但未缓解组残留疲劳VAS≥4分的患者比例明显高于缓解组(53.6%vs.27.9%,P=0.001);残留疼痛VAS≥4分的患者49例(24.4%),其中达到LDA但未缓解组残留疼痛VAS≥4分比例亦明显高于缓解组(30.0%vs.11.5%,P=0.005)。二元Logistic回归分析发现,CRP水平对于残留疲劳症状有显著的负性影响(B=-0.142,P=0.008,OR=0.868),国际脊柱关节炎评估协会-健康指数(Assessment of Spondyloarthritis International Society-health index,ASAS-HI)对于残留疲劳症状有显著的正性影响(B=0.288,P<0.001,OR=1.334);性别对于残留疼痛症状有显著影响,女性的残留疼痛症状风险更高(B=1.135,P=0.002,OR=3.112)。结论:残留疲劳和疼痛症状在达到LDA的ax-SpA患者中常见,尤其是女性患者;未来需要更多地关注和评估残留疾病负担,优化治疗方案。Objective:To comprehensively assess the occurrence of residual symptoms in patients with axial spondyloarthritis who have successfully attained the treatment goal of low disease activity,and to conduct a thorough analysis of the related factors.Methods:An analysis was performed on axial spondyloarthritis patients who achieved low disease activity for the first time during their visits at the Rheumatology and Immunology Department of Peking University Third Hospital,spanning from May 1,2021,to February 29,2024.Based on the ankylosing spondylitis disease activity score-C-reactive protein(ASDAS-CRP),the patients who achieved low disease activity were divided into a non-remission low disease activity group and a remission group.The occurrence of residual fatigue and pain symptoms in both groups was assessed,and binary Logistic regression analysis was used to evaluate the related factors.Results:In the study,201 patients achieved low disease activity during treatment.The gender distribution was skewed towards males,with 151 male patients(75.1%)and 50 female patients(24.9%).The median age of the patients who achieved low disease activity was 32.0(28.0,37.0)years,and the median disease duration was 6.7(3.8,11.5)years.Notably,140 patients(69.7%)achieved low disease activity but did not experience complete remission,while 61 patients(30.3%)attained remission.A substantial proportion of the patients,45.8%,reported residual fatigue visual analogue scale(VAS)≥4,with a marked difference between the non-remission low disease activity group and the remission group(53.6%vs.27.9%,P=0.001).Similarly,24.4%of the patients had residual pain VAS≥4,with a significant disparity between the non-remission low disease activity group and the remission group(30.0%vs.11.5%,P=0.005).Binary Logistic regression analysis revealed that C-reactive protein levels had a notable negative influence on residual fatigue symptom(B=-0.142,P=0.008,OR=0.868),whereas ASAS-HI had a positive effect on residual fatigue(B=0.288,P<0.001,OR=1.334).Gender was fo

关 键 词：中轴型脊柱关节炎 疾病活动度 疼痛 疲劳 相关因素 

分 类 号：R593.2[医药卫生—内科学]