银屑病关节炎患者合并恶性肿瘤的临床特征及相关因素分析  

Clinical characteristics and related factors of malignancy in patients with psoriatic arthritis

作　　者：付钰 陈姝妍 张卓莉[1] 耿研[1] Fu Yu;Chen Shuyan;Zhang Zhuoli;Geng Yan(Department of Rheumatology and Clinical Immunology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,北京100034

出　　处：《中华风湿病学杂志》2025年第2期103-109,共7页Chinese Journal of Rheumatology

基　　金：白求恩公益基金会"免疫炎症性疾病科研支持"项目(J202301E036);中央高水平医院临床科研业务费资助(北京大学第一医院跨学科交叉研究专项)(2024IR37)。

摘　　要：目的对银屑病关节炎(PsA)患者合并恶性肿瘤的情况进行描述,并进一步探索PsA发生肿瘤的相关因素。方法本研究基于北京大学第一医院风湿免疫科PsA前瞻随访队列(PKUPsA-PC)。收集2016年1月至2024年1月就诊PsA患者的人口学及临床特征,包括性别、年龄、病程、疾病活动度、用药情况等,记录分析合并恶性肿瘤的情况,采用非参数检验和χ^(2)检验比较合并与不合并恶性肿瘤2组PsA患者的临床特点,应用多因素logistic回归分析PsA合并肿瘤的相关因素。结果共入组382例PsA患者,22例(5.8%)合并恶性肿瘤,确诊肿瘤的中位年龄为56.4(45.8,67.3)岁,其中14例(63.6%)为女性,16例(72.7%)恶性肿瘤发生在PsA诊断后。关于肿瘤类型,绝大多数(21例,95.5%)为实体肿瘤,包括乳腺癌7例、泌尿系统肿瘤5例、皮肤癌3例、结/直肠癌2例,甲状腺癌、肝癌、子宫内膜原位癌和腹膜后恶性肿物各1例。仅1例(4.5%)为血液系统肿瘤(慢性淋巴细胞白血病)。与不合并恶性肿瘤的患者相比,合并恶性肿瘤的PsA患者中女性比例更高(63.6%与40.8%,χ^(2)=4.42,P=0.035),年龄更大[56.4(45.8,67.3)岁与47.0(36.0,56.6)岁,Z=-2.94,P=0.003],银屑病皮疹病程更长[20.0(11.2,33.5)年与14.0(6.0,23.0)年,Z=-2.02,P=0.043],PsA病程更长[8.0(4.0,17.0)年与3.0(1.0,7.0)年,Z=-2.65,P=0.008],HLA-B27阳性的比例更高(25.0%与4.4%,χ^(2)=3.98,P=0.046)。多因素logistic回归分析显示:年龄[OR值(95%CI)=1.056(1.008,1.107),P=0.023]、PsA病程[OR值(95%CI)=1.051(1.068,1.106),P=0.010],HLA-B27[OR值(95%CI)=5.086(1.278,20.2380),P=0.021]是PsA患者发生肿瘤的相关因素。结论PsA合并恶性肿瘤并不少见,其中乳腺癌、泌尿系统肿瘤和皮肤癌占比较高。年龄大、PsA病程长、HLA-B27阳性的PsA患者更需要警惕合并恶性肿瘤的可能。ObjectiveTo investigate the occurrence of malignancy in psoriatic arthritis(PsA)patients,and further explore the factors related to malignancy.MethodsBased on the PsA prospective follow-up cohort(PKUPsA-PC)in our center,we collected the demographics and clinical characteristics of patients who visited from January 2016 to January 2024,especially those regarding the malignant tumor.The clinical characteristics of patients with and without malignant tumor were compared through the method of non-parametric tests and chi-square tests.Multivariate logistic regression was applied to analyze the factors related to malignant tumors.ResultsThree hundred and eighty two patients with PsA were enrolled.The median follow-up duration was 6.0(2.8,12.8)years.Twenty two(5.8%)patients were complicated with malignant tumors.The median age of confirmed tumors was 56.4(45.8,67.3)years.Among them,14(63.6%)patients were female,and 16(72.7%)patients had malignant tumors after the diagnosis of PsA.As for the tumor types,solid tumors were great majority(21 cases,95.5%),including breast cancer(7 cases),urinary system tumors(5 cases),skin cancer(3 cases),colorectal/rectal cancer(2 cases),and thyroid cancer,liver cancer,endometrial carcinoma in situ,retroperitoneal malignant tumor(1 case respectively).There was only 1(4.5%)patient with hematological tumor(chronic lymphocytic leukemia).Compared with patients without malignant tumors,PsA patients with malignancy had a higher proportion of women(63.6%vs.40.8%,χ^(2)=4.42,P=0.035),older age[56.4(45.8,67.3)years vs.47.0(36.0,56.6)years,Z=-2.94,P=0.003],had a longer duration of psoriasis[20.0(11.2,33.5)years vs.14.0(6.0,23.0)years,Z=-2.02,P=0.043],a longer duration of arthritis[8.0(4.0,17.0)years vs.3.0(1.0,7.0)years,Z=-2.65,P=0.008],and a higher proportion of HLA-B27 positivity(25.0%vs.4.4%,χ^(2)=3.98,P=0.046).Age[OR(95%CI)=1.056(1.008,1.107),P=0.023],duration of PsA[OR(95%CI)=1.051(1.068,1.106),P=0.010],and HLA-B27 positivity[OR(95%CI)=5.086(1.278,20.238),P=0.021]were the factors related to the

关 键 词：银屑病关节炎 恶性肿瘤 临床特征 相关因素 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]