摘要
目的探索北京大学第一医院RA患者早期缓解率现状并探讨其预测因素。方法收集2009年1月1日至2016年12月31日所有就诊于北京大学第一医院风湿免疫科门诊的RA患者门诊病历资料,以DAS28-ESR计算疾病活动度数值与缓解情况,早期缓解定义为6个月内达到临床缓解标准。采用向后法Logistic回归分析确定早期缓解的独立预测因素。结果本研究共纳入779例患者,317(40.7%)例患者达到早期缓解标准,在达到早期缓解患者中,达早期缓解的中位时间为2.8(1.8~4.0)个月。相较于非早期缓解患者,早期缓解组中男性比例高(26.5%和16.5%,χ^2=11.631,P=0.001)、起病年龄早[(47±16)岁和(49±16)岁,t=2.925,P=0.004]、初治比例高(64.7%和53.5%,χ^2=9.692,P=0.002)、病程短[14(4,72)和24(6,96),Z=3.126:P=0.003]、早期RA比例高(50.4%和40.9%,χ^2=7.656,P=0.01)、基线疾病活动度相关指标[压痛关节数(TJC)、肿胀关节数(SJC)、患者对病情活动度的总体评估(PGA)、医师对患者病情活动度的总体评估(EGA)、ESR、CRP、DAS28-ESR]低[(4.33±1.21)和(4.92±1.38),t=6.118,P<0.01]、初始治疗使用激素比例低(36.0%和44.6%,χ^2=5.780,P=0.018)、初始治疗使用羟氯喹的比例高(44.8%和34.0%,χ^2=9.293,P=0.003)。而在血清学抗体及其他初始药物治疗上差异无统计学意义。进一步Logistic回归分析发现,男性[OR=1.70,95%CI(1.16,2.47)]、初治[OR=1.64,95%CI(1.20,2.24)]、初始治疗使用羟氯喹[OR=1.87,95%CI(1.37,2.56)]是易达到早期缓解的主要因素,而起病年龄越晚[OR=0.99,95%CI(0.98,1.00)]、基线DAS28-ESR越高[OR=0.70,95%CI(0.62,0.79)]则不易实现早期缓解(P<0.05)。结论在临床工作中,RA早期缓解并不常见,仅见于不到半数的患者。男性、初治、初始治疗使用羟氯喹患者易达到早期缓解,而起病年龄越晚、基线DAS28-ESR越高则不易达到早期缓解。
Objective To investigate the early remission rate of rheumatoid arthritis (RA) and identify the potential predictive factors in Chinese population. Methods For this study, medical records of RA patients during January 1, 2009 to December 31, 2016 were retrospectively reviewed. Disease activity scores at visits were measured by (disease activity score uses 28 joint counts (DAS28)-erythrocyte sedimentation rate (ESR) and remission status was determined subsequently. Early remission was defined as the time interval between first visit and clinical remission for less than 6 months. Logistic regression analysis was applied to identify predictive factors for early remission. Results Seven hundred and seventy nine patients in total were included into the present study. Overall, 317(40.7%) patients achieved early remission and the median time to early remission was 2.8(1.8, 1.4) months. Comparison of characteristics between RA patients with and without early remission, male gender (26.5% vs 16.5%, χ^2=11.631, P=0.001) , treatment-na?ve (64.7% vs 53.5%, χ^2=9.692, P=0.002), early RA (50.4% vs 40.9%, χ^2=7.656, P=0.01), as well as initial use of hydroxy-chloroquine (44.8% vs 34.0%, χ^2=9.293, P=0.003) was significantly higher in patients with early remission. Conversely early remission was less frequent in patients with late onset [(49±16) vs (47±16), t=2.925, P=0.003], long disease duration [24(6, 96) vs 14(4, 72), Z=3.126, P=0.003] high level of all baseline individual com-ponents of disease activity [(TJC, SJC, PGA, EGA, ESR, C-reactive protein (CRP)] and DAS28-ESR [(4.33±1.21) vs (4.92±1.38), t=6.118, P<0.01], as well as initial treated with glucocorti-coids (44.6% vs 36.0%, χ^2=5.780, P<0.05). No significant differences were observed in terms of serological features, initial used of MTX, LEF, SSZ, as well as DAMRDs combination. Further logistic regression analyses identified that male [OR=1.70, 95%CI(1.16, 2.47)], treatment-na?ve [OR=1.64, 95%CI(1.20, 2.24)], and treatment with hydroxy-chloroquine initially [OR=1.87, 95%CI(1.37, 2.56)] as independent factors associated with early remission. In contrast, late disease onset [OR=0.99, 95%CI(0.98, 1.00)], high baseline DAS28-ESR [OR=0.70, 95%CI(0.62, 0.79)] were independently associated with decreased possibility of early remission (P<0.05). Conclusion Early remission is uncommon in clinical practice. Male, treatment-na?ve, and initial hydroxychloroquine treatment increases the probability of early remission, while advanced age, higher baseline DAS28-ESR decreases the chance of early remission.
作者
谢文慧
张卓莉
Xie Wenhui;Zhang Zhuoli(Department of Rheumatology and Clinical Immunology,Peking University First Hospital,Beijing 100034, China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2019年第1期25-30,共6页
Chinese Journal of Rheumatology
基金
国家“973”科技支撑项目(2010CB529100)
国家自然科学基金(81771740)
首都卫生发展科技专项基金(2011-4021-03).
