类风湿关节炎病例特征和免疫因子水平及对预后影响研究

doi:10.12183/j.scjpm.2024.0119

摘要/Abstract

摘要： 目的研究类风湿关节炎病例特征和免疫因子水平及对预后的影响。方法以2021年1月1日至2022年12月31日卫辉市某医院诊治的类风湿关节炎患者作为研究对象,采用描述性分析方法对类风湿关节炎病例特征进行分析,根据28个关节疾病活动度（DAS28）评分在患者出院后3个月复查时评估预后,经单、多因素分析确定预后影响因素。结果类风湿关节炎患者1 031例,男女性别比0.67∶1,37~50岁年龄段比例最高（47.72%）,对称性多关节炎为主（94.57%）,小关节受累为主（80.12%）,主要表现为晨僵（86.42%,891/1 031）、关节痛和压痛（88.94%,917/1 031）、关节肿胀（66.34%,684/1 031）。DAS28评分提示预后良好患者328例（31.81%）,预后不良患者703例（68.19%）,预后良好患者类风湿关节炎患者红细胞沉降率（ESR）、类风湿因子（RF）、C反应蛋白（CRP）水平均显著低于预后不良患者,差异有统计学意义（均P<0.01）。多因素Logistic回归分析结果提示年龄（OR=1.790）、受累关节数（OR=3.025）、应用糖皮质激素（OR=0.266）、ESR水平（OR=1.270）、RF水平（OR=2.208）、CRP水平（OR=1.447）、应对方式（回避OR=1.404、屈服OR=2.330）、功能状态分级（OR=1.132）均为类风湿关节炎预后影响因素。结论类风湿关节炎病例具有一定的性别、年龄分布特征及发病特点,ESR、RF、CRP水平升高,患者预后受到年龄、受累关节数、应用糖皮质激素及ESR、RF、CRP水平、应对方式、功能状态多种因素影响,针对个体特点并通过监测ESR、RF、CRP水平等,及早对患者采取针对性干预措施可控制病情发展,改善预后。

关键词: 类风湿关节炎, 病例特征, 免疫因子, 预后, 影响因素

Abstract: Objective To study the characteristics and immune factor levels of rheumatoid arthritis cases and their impact on prognosis. Methods Patients with rheumatoid arthritis diagnosed and treated in a hospital of Weihui City from January 1,2021 to December 31,2022 were selected for this study. Descriptive analysis was used to analyze the characteristics of rheumatoid arthritis cases. According to the 28 joint Disease Activity Score （DAS28）,the prognosis was evaluated at three months after discharge,and the prognostic factors were determined by univariate and multivariate analyses. Results There were 1 031 patients with rheumatoid arthritis,with a male to female ratio of 0.67∶1. The highest proportion was found in the age group of 37 to 50 years old,accounting for 47.72%. Symmetric polyarthritis was predominant,accounting for 94.57%,and small joint involvement was predominant,accounting for 80.12%. The main manifestations were morning stiffness （86.42%,891/1 031）,joint pain and tenderness （88.94%,917/1 031）,and joint swelling （66.34%,684/1 031）. The DAS28 score showed that there were 328 patients （31.81%）with good prognosis and 703 patients （68.19%）with poor prognosis. The erythrocyte sedimentation rate （ESR）,rheumatoid factor （RF）,and C-reactive protein （CRP）levels in rheumatoid arthritis patients with good prognosis were significantly lower than those with poor prognosis,and the differences were statistically significant （all P<0.01）. The results of multivariate logistic regression analysis indicated that age （OR=1.790）,number of affected joints （OR=3.025）,use of glucocorticoids （OR=0.266）,ESR level （OR=1.270）,RF level （OR=2.208）,CRP level （OR=1.447）,coping strategies （avoidance OR=1.404,yielding OR=2.330）,and functional status （OR=1.132）were all prognostic factors for rheumatoid arthritis. Conclusions Rheumatoid arthritis cases have certain gender,age distribution characteristics,and pathogenesis characteristics,and the levels of ESR,RF and CRP are increased. The prognosis of patients is affected by multiple factors such as age,number of affected joints,the use of glucocorticoids,levels of ESR,RF,and CRP,coping strategies,and functional status. According to individual characteristics and by monitoring ESR,RF,and CRP levels,targeted interventions should be taken to control the development of the disease and improve the prognosis.

Key words: Rheumatoid arthritis, Case characteristics, Immune factor, Prognosis, Influencing factor

中图分类号:

R593.22

高燕, 任振辉, 蒋振娇, 马海军, 孙丹丹. 类风湿关节炎病例特征和免疫因子水平及对预后影响研究[J]. 华南预防医学, 2024, 50(2): 119-123.

GAO Yan, REN Zhenhui, JIANG Zhenjiao, MA Haijun, SUN Dandan. Study on the characteristics and immune factor levels of rheumatoid arthritis cases and their impact on prognosis[J]. South China Journal of Preventive Medicine, 2024, 50(2): 119-123.

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