外周型脊柱关节炎的临床特征及治疗选择分析  

Clinical Characteristics and Treatment Options of Peripheral Spondyloarthritis

作　　者：曾露露 冀肖健 胡立冬 胡嘉文 张奕楠 张家鑫 刘兴康 杨世伟 黄烽 ZENG Lulu;JI Xiaojian;HU Lidong;HU Jiawen;ZHANG Yinan;ZHANG Jiaxin;LIU Xingkang;YANG Shiwei;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]中国人民解放军总医院第一医学中心风湿免疫科,北京100853

出　　处：《协和医学杂志》2025年第1期50-58,共9页Medical Journal of Peking Union Medical College Hospital

基　　金：新疆维吾尔自治区重点研发计划(2022B03002-3);青年自主创新科学基金-扶持项目(22QNFC139);北京市自然科学基金-海淀原始创新联合基金(L242143)。

摘　　要：目的比较外周型脊柱关节炎(peripheral spondyloarthritis,pSpA)与中轴型脊柱关节炎(axial spondyloarthritis,axSpA)的临床特征和治疗选择差异,分析pSpA的临床特点及用药需求。方法本研究为回顾性队列研究。选取2016年1月—2022年12月首次就诊于中国人民解放军总医院第一医学中心且诊断符合国际脊柱关节炎协会制定的axSpA或pSpA分类标准的患者为研究对象。通过电子病历管理系统和脊柱关节炎智能管理系统获取患者的人口学数据、临床特征、实验室检查及治疗情况。比较pSpA与axSpA患者,以及pSpA1(除外银屑病关节炎)与axSpA患者的关节肿胀和压痛分布情况,并比较其临床特征和治疗选择差异。结果共纳入脊柱关节炎患者1639例,其中pSpA患者184例(含银屑病关节炎97例),axSpA患者1455例。相较于axSpA患者,pSpA男性患者更少(62.5%比79.7%,P<0.001)、发病年龄更晚(33.8岁比22.0岁,P<0.001),诊断延误时间更短(6.0个月比14.2个月,P=0.004),伴随外周关节炎(71.7%比9.3%,P<0.001)和指/趾炎(6.5%比0.3%,P<0.001)更多,合并银屑病更多(52.7%比1.1%,P<0.001),且银屑病家族史更普遍(11.4%比3.4%,P<0.001);炎症指标更高但人类白细胞抗原(human leukocyte antigen,HLA)-B27阳性率更低(43.5%比87.4%,P<0.001),且HLA-B27阳性与发病年龄较早、较少合并银屑病、具有强直性脊柱炎家族史相关。pSpA患者使用传统合成改善病情抗风湿药物(conventional synthetic disease-modifying antirheumatic drugs,csDMARDs)、生物类改善病情抗风湿药物(biologic disease-modifying antirheumatic drugs,bDMARDs)和口服糖皮质激素的占比更高,同时更多采用bDMARDs与csDMARDs联合用药(19.0%比12.2%,P=0.009)或多种csDMARDs合用(65.8%比12.5%,P<0.001)。相较于axSpA患者,pSpA1患者除合并银屑病、合并葡萄膜炎、银屑病家族史及bDMARDs用药无统计学差异外,其余变量的亚组分析与pSpA患者结果一致。结论pSpA患者通常发病较晚,�Objective To compare the differences in clinical features and treatment choices between peripheral spondyloarthritis(pSpA)and axial spondyloarthritis(axSpA),and better understand the clinical characteristics and medication needs of pSpA.Methods Our study is a retrospective cohort study.The patients who first visited the First Medical Center of Chinese PLA General Hospital between January 2016 and December 2022 and were diagnosed with axSpA or pSpA according to the classification criteria established by the Assessment of SpondyloArthritis International Society were selected as the study subjects.Demographic data,clinical characteristics,laboratory tests,and treatment information of these patients were obtained through the electronic medical records management system and the intelligent management system for spondyloarthritis.The research compared the distribution of swollen and tender joints between pSpA and axSpA patients,as well as that between pSpA1(excluding patients with psoriatic arthritis)and axSpA patients.Additionally,we analyzed differences in clinical features and treatment options among these groups.Results A total of 1639 patients were included in the study,of which 184 had pSpA(including 97 with psoriatic arthritis),and 1455 had axSpA.Compared to axSpA patients,pSpA patients had fewer male patients(62.5%vs.79.7%,P<0.001),later onset age(33.8 years vs.22.0 years,P<0.001),shorter diagnostic delays(6.0 months vs.14.2 months,P=0.004),more associated peripheral arthritis(71.7%vs.9.3%,P<0.001)and dactylitis(6.5%vs.0.3%,P<0.001),more cases of psoriasis(52.7%vs.1.1%,P<0.001)and a more common family history of psoriasis(11.4%vs.3.4%,P<0.001).pSpA patients had higher levels of inflammatory markers but a lower positive rate of human leukocyte antigen(HLA)-B27(43.5%vs.87.4%,P<0.001).A positive HLA-B27 was associated with an earlier onset age,fewer cases of psoriasis,and a family history of ankylosing spondylitis.pSpA patients had a higher proportion of using conventional synthetic disease-modifying antirheumatic

关 键 词：外周型脊柱关节炎 中轴型脊柱关节炎 临床特征 药物治疗 

分 类 号：R681.51[医药卫生—骨科学] R684.3[医药卫生—外科学] R758.63[医药卫生—临床医学]