难治性类风湿关节炎预测因素及模型构建  

Predictive factors and model construction of difficult-to-treat rheumatoid arthritis

作　　者：刘潇潇 翁约约 李素蘋 徐晓作 李震岳 LIU Xiaoxiao;WENG Yueyue;LI Supin;XU Xiaozuo;LI Zhenyue(Department of Pharmacy,Wenzhou Central Hospital,Wenzhou 325000,China;不详)

机构地区：[1]温州市中心医院药剂科,325000 [2]温州市中心医院风湿免疫科,325000

出　　处：《浙江医学》2025年第6期615-618,共4页Zhejiang Medical Journal

基　　金：温州市基础性科研项目(Y20240382)。

摘　　要：目的探讨难治性类风湿关节炎(D2T-RA)的独立预测因素并构建预测模型。方法回顾性收集2022年1月至2023年1月温州市中心医院收治的80例类风湿关节炎(RA)患者,将符合D2T-RA诊断标准的40例设为观察组,另40例设为对照组。收集并比较两组患者的临床病理资料,采用多因素logistic回归分析D2T-RA发病的独立危险因素,绘制ROC曲线评估相关因素预测D2T-RA的效能,基于独立危险因素构建预测模型;使用模型质量评分验证模型的稳健性。结果观察组病程、类风湿因子(RF)-免疫球蛋白(Ig)A水平、RF-IgM水平均低于对照组,合并骨质疏松症(OP)患者数、口服糖皮质激素(GC)单日最大剂量、抗环瓜氨酸肽(CCP)抗体水平、RF-IgG水平均高于对照组(均P<0.05);多因素logistic回归分析显示,合并OP、口服GC单日最大剂量及抗CCP抗体水平均为D2T-RA发病的独立危险因素(均P<0.05)。ROC曲线分析显示,合并OP、口服GC单日最大剂量、抗CCP抗体水平及3项指标联合预测D2T-RA发病的AUC分别为0.838、0.825、0.826、0.938,其中联合指标最高,其灵敏度、特异度分别为0.900、0.925。联合指标模型整体表现优于单一指标模型,模型质量评分为0.85。结论合并OP、高剂量口服GC及抗CCP抗体水平是D2T-RA的独立预测因素,联合指标模型可为早期识别高危患者提供高精度工具。Objective To explore independent predictive factors for difficult-to-treat rheumatoid arthritis(D2T-RA)and establish a prediction model.Methods This study included 80 rheumatoid arthritis(RA)patients admitted to Wenzhou Central Hospital from January 2022 to January 2023.Forty patients diagnosed with D2T-RA were assigned to the observation group,and another forty patients diagnosed with RA were assigned to the control group.Detailed baseline data were collected from all patients.Multivariate logistic regression analyses were performed to explore the independent risk factors influencing the onset of D2T-RA.ROC curve was drawn to evaluate the efficiency of correlation factors in predicting D2T-RA,and then constructed prediction model based on independent risk factors.Model quality score was calculated to verify the robustness of the model.Results Univariate analysis revealed that the observation group had significantly shorter disease duration,lower levels of rheumatoid factor(RF)-immune globulin(Ig)A and RF-IgM,but higher proportions of osteoporosis(OP)comorbidity,maximum daily dose of oral glucocorticoids(GC),anti-cyclic citrullinated peptide(CCP)antibody level,and RF-IgG level when comparing to the control group(all P<0.05).Multivariate logistic regression analysis revealed that OP comorbidity,maximum daily dose of oral GC and anti-CCP antibody level were independent predictors of D2T-RA(all P<0.05).ROC curve analysis demonstrated that the combined model achieved the highest AUC of 0.938 with sensitivity of 0.900,and specificity of 0.925,outperforming individual predictors(AUC:OP=0.838,GC=0.825,anti-CCP antibody=0.826).The overall performance of the combined model was better than that of the single index model,with a model quality score of 0.85.Conclusion The presence of OP comorbidity,high-dose oral GC use,and anti-CCP antibody levels are inde-pendent predictors of D2T-RA.The combined model provides a high-precision tool for early identification of high-risk patients.

关 键 词：骨质疏松症 口服糖皮质激素 难治性类风湿关节炎 

分 类 号：R59[医药卫生—内科学]