本文選題：關(guān)節(jié)炎　切入點(diǎn)：類風(fēng)濕　出處：《中國(guó)全科醫(yī)學(xué)》2017年18期 　論文類型：期刊論文

【摘要】：目的探討類風(fēng)濕關(guān)節(jié)炎(RA)患者共病現(xiàn)象的臨床特點(diǎn)及其相關(guān)影響因素,為全面評(píng)估患者預(yù)后及干預(yù)疾病提供臨床依據(jù)。方法回顧性選取2013年1—12月在浙江省溫州醫(yī)科大學(xué)附屬第一醫(yī)院風(fēng)濕免疫科診治的符合納入標(biāo)準(zhǔn)的223例RA患者的臨床資料。記錄患者一般資料和輔助檢查結(jié)果,統(tǒng)計(jì)患者的共病情況,并分析RA共病現(xiàn)象與各指標(biāo)的相關(guān)性及其影響因素。結(jié)果 223例RA患者中84.8%(189/223)存在共病現(xiàn)象,共發(fā)現(xiàn)16種,主要為高脂血癥(41.3%,92/223)、高血壓(40.8%,91/223)、骨質(zhì)疏松癥或骨量減少(以下簡(jiǎn)稱骨松)(24.7%,55/223)、糖尿病(17.5%,39/223)、高尿酸血癥(13.9%,31/223)、腎結(jié)石(13.5%,30/223)等。RA合并高脂血癥與疾病活動(dòng)指數(shù)(DAS28)評(píng)分(r_s=-0.146)、紅細(xì)胞沉降率(ESR)(r_s=-0.153)、血壓(r_s=0.194)、血尿酸(r_s=0.216)存在直線相關(guān)關(guān)系(P0.05);RA合并高血壓與年齡(r_s=0.353)、壓痛關(guān)節(jié)數(shù)(TJC)(r_s=0.161)、腫脹關(guān)節(jié)數(shù)(SJC)(r_s=0.148)、血糖(r_s=0.290)、血脂(r_s=0.194)、血尿酸(r_s=0.220)、骨密度異常(r_s=0.202)存在直線相關(guān)關(guān)系(P0.05);RA合并骨松與男性(r_s=-0.173)、年齡(r_s=0.362)、血壓(r_s=0.202)存在直線相關(guān)關(guān)系(P0.05);RA合并糖尿病與年齡(r_s=0.245)、TJC(r_s=0.145)、DAS28評(píng)分(r_s=0.182)、C反應(yīng)蛋白(CRP)(r_s=0.195)、血壓(r_s=0.290)存在直線相關(guān)關(guān)系(P0.05);RA合并高尿酸血癥與男性(r_s=0.141)、年齡(r_s=0.172)、血壓(r_s=0.220)、血脂(r_s=0.216)存在直線相關(guān)關(guān)系(P0.05);RA合并腎結(jié)石與CRP存在直線相關(guān)關(guān)系(r_s=0.135,P0.05)。Logistic回歸分析示,血壓、血尿酸是RA合并高脂血癥的危險(xiǎn)因素(P0.05);年齡、血糖、血脂、血尿酸是RA合并高血壓的危險(xiǎn)因素(P0.05);女性、年齡為RA合并骨松的危險(xiǎn)因素(P0.05);RA病程、CRP、血壓為RA合并糖尿病的危險(xiǎn)因素(P0.05);男性、血壓、血脂為RA合并高尿酸血癥的危險(xiǎn)因素(P0.05)。結(jié)論 RA患者易發(fā)生共病現(xiàn)象,以高脂血癥、高血壓、骨松、糖尿病、高尿酸血癥等為主,導(dǎo)致上述共病現(xiàn)象的主要影響因素有性別、年齡、血壓、血脂等;而這些共病現(xiàn)象影響RA患者的預(yù)后和生活質(zhì)量,因此,臨床上除積極治療原發(fā)病外,同時(shí)需要充分認(rèn)識(shí)RA患者共病現(xiàn)象并對(duì)其進(jìn)行篩查和有效管理,才能更好地改善RA預(yù)后及減輕共病所致的相關(guān)后果。
[Abstract]:Objective to investigate the clinical characteristics and related factors of co-disease in patients with rheumatoid arthritis (RA). Methods the clinical data of 223 RA patients who were diagnosed and treated in the Department of Rheumatology Immunology affiliated to Wenzhou Medical University in Zhejiang Province from January to December in 2013 were selected retrospectively. Bed data. Records of patients' general information and results of auxiliary examinations, The incidence of co-disease in patients with RA was analyzed, and the correlation and influencing factors were analyzed. Results among 223 patients with RA, 84.8 / 223 (18.9 / 223) were found to be co-diseased, and 16 of them were found. The main ones are hyperlipidemia 41.32 / 222, hypertension 40.8g / 91 / 223, osteoporosis or reduction of bone mass (hereinafter referred to as Osteoporosis 24.775% 55 / 2223, diabetes 17.555 / 39 / 2223, hyperuricemia 13.931 / 3223, renal calculi 13.550 / 30223) .RA with hyperlipidemia and disease activity index (DAS28) scores RSS-0.146, erythrocyte sedimentation rate and erythrocyte sedimentation rate. There is a linear correlation between the number of hypertensives and age, the number of tenderness joints, the number of swollen joints, the number of swollen joints, the number of swollen joints, the number of SJCCrs0.148, the blood glucose of 0.290, the blood fat of 0.194, the serum uric acid of 0.220, the abnormal bone density of 0.220, the abnormal bone density of 0.202). There is a linear correlation between RA with diabetes mellitus and age with diabetes mellitus and DAS28 with DAS28 score rs0. 182C-reactive protein CRPrs0. 290). There is a linear correlation between Rs0. 05 and Rs0. 290). There is a linear correlation between Rs0. 05 and Rs0. 141 in men, 0. 172 in age, 0. 220 in blood pressure, 0. 220 in blood lipids.) there is a linear correlation between 0. 05 and 0. 141, 0. 172, 0. 220, 0. 220, 0. 216.) there is a linear correlation between Rs0. 05 and Rs0. 141, age and age, 0. 172, 0.220, 0.220, and 0. 216). There was a linear correlation between RA and CRP. Logistic regression analysis showed that there was no significant difference between RA and CRP. Blood pressure and uric acid were the risk factors of RA with hyperlipidemia, age, blood glucose, blood lipid and serum uric acid were risk factors of RA with hypertension. Age is the risk factor of RA combined with osteosarcoma (P 0.05), the course of RA is CRP, the blood pressure is the risk factor of RA with diabetes mellitus (P 0.05), the male, blood pressure and blood lipid are the risk factors of RA with hyperuricemia (P 0.05). Conclusion the patients with RA are prone to co-disease, and hyperlipidemia is the risk factor. Hypertension, osteosarcoma, diabetes, hyperuricemia and so on, the main factors that cause these syndromes are sex, age, blood pressure, blood lipids, etc., and these co-diseases affect the prognosis and quality of life of patients with RA. In addition to active treatment of the primary disease, it is necessary to fully understand, screen and manage the co-disease phenomenon in RA patients, so as to improve the prognosis of RA and alleviate the related consequences.
【作者單位】： 浙江省樂(lè)清市人民醫(yī)院內(nèi)科;浙江省玉環(huán)縣人民醫(yī)院影像科;溫州醫(yī)科大學(xué);溫州醫(yī)科大學(xué)附屬第一醫(yī)院風(fēng)濕免疫科;
【分類號(hào)】：R593.22

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