类风湿关节炎患者手功能障碍的特征及其相关因素分析  

The characteristics and associated factors of hand dysfunction in patients with rheumatoid arthritis

作　　者：邹耀威 杨迎 欧阳志明[1] 潘婕 贾霈雯 杨葵敏 郑湖伟 吴滔 林建子 马剑达[1] 莫颖倩[1] 戴冽[1] Zou Yaowei;Yang Ying;Ouyang Zhiming;Pan Jie;Jia Peiwen;Yang Kuimin;Zheng Huwei;Wu Tao;Lin Jianzi;Ma Jianda;Mo Yingqian;Dai Lie(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：《中华内科杂志》2025年第2期119-127,共9页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(82171780);广东省基础与应用基础研究基金(2023A1515030253,2414050002681)。

摘　　要：目的探讨类风湿关节炎(RA)患者手功能障碍的特征及其相关因素。方法本研究为横断面研究,纳入2019年1月至2024年4月就诊于中山大学孙逸仙纪念医院风湿免疫科的RA患者。收集患者的临床资料,包括年龄、性别、吸烟史、病程、晨僵时间、类风湿因子、抗环瓜氨酸肽抗体、疾病活动指标、关节放射学评估指标和手功能评估指标,手功能评估包括握力和斯坦福健康评估问卷自我报告的手功能。采用logistic回归分析与手功能相关的因素。结果共纳入1079例RA患者,年龄(53.0±12.6)岁,72.6%(783/1079)的患者有握力下降,57.2%(617/1079)双手握力同时下降,左、右手的平均握力较正常值分别下降16.3%和14.1%;39.9%(430/1079)的患者有自我报告手功能障碍。老年RA(年龄≥65岁)患者185例(17.1%),有握力下降的患者比例[89.7%(166/185)]及握力下降程度(左手:-35.3%±30.6%,右手:-32.6%±32.3%)均高于年轻RA患者[69.0%(617/894),左手:-12.3%±38.6%;右手:-10.3%±42.1%](均P<0.001),且有自我报告手功能障碍的患者比例也明显升高[53.0%(98/185)比37.1%(332/894),P<0.001]。多因素logistic回归分析显示,疼痛视觉模拟评分(OR=1.375,95%CI 1.020~1.854)是老年RA患者握力下降的独立相关因素,28个压痛关节数(OR=1.151,95%CI 1.063~1.246)和医生总体疾病活动度评估(OR=1.381,95%CI 1.171~1.628)是自我报告手功能障碍的独立相关因素。结论RA尤其是老年RA患者有明显的手功能障碍,并且与疼痛、关节压痛和医生总体疾病活动度评估相关,提示应重视RA患者疼痛的管理。ObjectiveTo investigate the characteristics of hand dysfunction and its associated factors in patients with rheumatoid arthritis(RA).MethodsA cross-sectional study.Patients with RA were recruited from January 2019 to April 2024 at the Department of Rheumatology and Immunology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University.Demographic and clinical data were collected,including age,gender,active smoking,disease duration,time of morning stiffness,rheumatoid factor and anti-cyclic citrullinated peptide antibody,disease activity,radiographic indicators,and hand function assessment.Hand function was assessed by grip strength measures and self-reported items related to hand function in the Stanford Health Assessment Questionnaire.Factors related to hand function were analyzed by logistic regression analyses.ResultsA total of 1079 RA patients were recruited[mean age:(53.0±12.6)years].Overall,72.6%(783/1079)patients experienced a decrease in grip strength,57.2%(617/1079)patients experienced a decreased grip strength in both hands,with the average grip strength of the left and right hands decreasing by 16.3%and 14.1%,respectively,compared to normal values;39.9%(430/1079)patients had self-reported hand dysfunction.There were 185(17.1%)older RA patients(age≥65 years).The proportion of older RA patients with decreased grip strength[89.7%(166/185)vs.69.0%(617/894)]and degree of decrease in grip strength compared to normal values(left hand:-35.3%±30.6%vs.-12.3%±38.6%;right hand:-32.6%±32.3%vs.-10.3%±42.1%)were significantly higher than that in young patients,and the proportion of older patients with self-reported hand dysfunction was also significantly higher[53.0%(98/185)vs.37.1%(332/894),all P<0.001].Multivariate logistic regression analysis showed that pain visual analogue scale(OR=1.375,95%CI 1.020-1.854)was independently associated with grip strength decrease in older RA patients,while the 28-joint tender joint count(OR=1.151,95%CI 1.063-1.246)and provider global assessment of disease activity(OR=1.381,95%CI 1

关 键 词：关节炎 类风湿 老年人 手功能 

分 类 号：R593.22[医药卫生—内科学]