Retrospective analysis of comorbidities and distribution differences in 511 patients with rheumatoid arthritis
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摘要:
目的 探讨类风湿关节炎(RA)患者的共患病状况及在不同年龄、性别、病程中的分布差异，为临床更好地综合防治RA及其共患病提供参考。 方法 回顾性分析2019年12月—2022年10月太和县中医院风湿科归档的511例RA住院病历，统计共患病数据，并分析不同年龄、性别、病程RA病例在共患病方面的分布差异。 结果 (1) 511例RA患者的共患病涉及多个系统，构成比最高的为心脑血管系统疾病332例(64.97%)，其次为运动系统疾病318例(62.23%)，血液系统疾病229例(44.81%)，内分泌系统疾病112例(21.92%)，呼吸系统疾病81例(15.85%)，其他风湿性疾病24例(4.70%)，传染性疾病9例(1.76%)。(2)与男性组比较，女性组共患病中骨关节病、间质性肺病、脑梗死、贫血的患者显著增多(均P<0.05)。(3)与<60岁组比较，≥60岁组共患间质性肺病、骨质疏松、高血压、冠心病、心力衰竭、脑梗死、2型糖尿病、贫血、腰椎间盘突出的患者显著增多(均P<0.05)。(4)与<1年组比较，1~3年组、>3年组共患骨质疏松、贫血、腰椎间盘突出的患者显著增多(均P<0.05)；与1~3年组比较，>3年组共患骨质疏松、高血压、脑梗死、贫血、颈椎病的患者显著增多(均P<0.05)。 结论 RA患者共患其他疾病者较多，且常涉及多个系统；并且在不同年龄、性别、病程时间患者中存在分布差异。 Abstract:Objective To investigate the comorbidities of patients with rheumatoid arthritis (RA) and their distribution differences in different age, gender and course of disease, and to provide reference for better comprehensive prevention and treatment of RA and comorbidities. Methods Retrospective analysis was performed on 511 inpatient medical records of RA filed in the Rheumatology Department of Taihe County Hospital of Traditional Chinese Medicine from December 2019 to October 2022, statistical data of comorbidities were collected, and the differences in the distribution of comorbidity in rheumatoid arthritis cases with different ages, genders and course of disease were analyzed. Results (1) The comorbidities of 511 RA patients involved multiple systems and the highest constituent ratio was cardio-cerebrovascular system diseases in 332 cases (64.97%), followed by motor system diseases in 318 cases (62.23%), hematological diseases in 229 cases (44.81%) and endocrine system diseases in 112 cases (21.92%), respiratory diseases in 81 cases (15.85%), other rheumatic diseases in 24 cases (4.70%) and infectious diseases in 9 cases (1.76%). (2) Compared with the male group, the incidence of osteoarthropathy, interstitial pneumonia, cerebral infarction and anemia in the female group was significantly increased (P<0.05). (3) Compared with<60 years old group, the incidence of interstitial pneumonia, osteoporosis, hypertension, coronary heart disease, heart failure, cerebral infarction, type 2 diabetes mellitus, anemia and lumbar disc herniation in ≥60 years old group was significantly increased (all P<0.05). (4) Compared with<1 year group, the incidence of osteoporosis, anemia and lumbar disc herniation in 1-3 years group and > 3 years group were significantly increased (all P<0.05). Compared with the 1-3 years group, the incidence of osteoporosis, hypertension, cerebral infarction, anemia and cervical spondylosis in the > 3 years group was significantly increased (all P<0.05). Conclusion More RA patients have comorbidities, often involving multiple systems; and their distribution differences in different in different age, sex and duration of disease. -
Key words:
- Rheumatoid arthritis /
- Comorbidities /
- Distribution difference
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表 1 511例RA患者共患病的发生频次
Table 1. Frequency of comorbidity in 511 RA patients
共患病 类别 例数 构成比(%) 其他风湿性疾病 干燥综合征 21 4.11 强直性脊柱炎 1 0.20 原发性胆汁性肝硬化 2 0.39 心脑血管系统疾病 冠心病 43 8.41 高血压 225 44.03 心力衰竭 9 1.76 脑梗死 55 10.76 呼吸系统系统疾病 间质性肺病 69 13.50 慢性阻塞性肺疾病 10 1.96 支气管哮喘 2 0.39 传染性疾病 乙肝 9 1.76 血液系统疾病 贫血 229 44.81 内分泌系统疾病 2型糖尿病 83 16.24 甲减 18 3.52 甲亢 11 2.15 运动系统疾病 颈椎病 15 2.94 腰椎间盘突出 72 14.09 骨关节病 86 16.83 骨质疏松 133 26.03 椎体压缩性骨折 12 2.35 
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表 2 不同年龄RA患者共患病的发生频次比较[例(%)]
Table 2. Comparison of the frequency of comorbidity in RA patients of different ages [cases (%)]
共患病 <60岁组
(n=250)≥60岁组
(n=261)χ2值 P值 干燥综合征 8(3.20) 13(4.98) 1.028 0.311 强直性脊柱炎 1(0.40) 0 1.046 0.306 骨关节病 44(17.60) 42(16.09) 0.207 0.649 间质性肺病 9(3.60) 60(22.99) 41.098 <0.001 原发性胆汁性肝硬化 0 2(0.77) 1.923 0.166 骨质疏松 36(14.40) 97(37.16) 34.370 <0.001 椎体压缩性骨折 3(1.20) 9(3.45) 2.815 0.093 冠心病 7(2.80) 36(13.79) 20.023 <0.001 高血压 69(27.60) 156(59.77) 53.624 <0.001 心力衰竭 1(0.40) 8(3.07) 5.242 0.022 脑梗死 9(3.60) 46(17.62) 26.149 <0.001 慢性阻塞性肺疾病 2(0.80) 8(3.07) 3.415 0.065 支气管哮喘 1(0.40) 1(0.38) 0.001 0.976 乙肝 6(2.40) 3(1.15) 1.154 0.283 贫血 96(38.40) 133(50.96) 8.142 0.004 2型糖尿病 21(8.40) 62(23.75) 22.129 <0.001 甲减 9(3.60) 9(3.45) 0.009 0.926 甲亢 8(3.20) 3(1.45) 2.549 0.110 颈椎病 6(2.40) 9(3.45) 0.492 0.483 腰椎间盘突出 19(7.60) 53(20.31) 17.032 <0.001
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表 3 不同性别RA患者共患病的发生频次比较[例(%)]
Table 3. Comparison of the frequency of comorbidity in RA patients of different genders [cases (%)]
共患病 男性
(n=119)女性
(n=392)χ2值 P值 干燥综合征 2(1.68) 19(4.85) 2.322 0.128 强直性脊柱炎 0 1(0.26) 0.304 0.581 骨关节病 11(9.24) 75(19.13) 6.378 0.012 间质性肺病 25(21.01) 44(11.22) 7.482 0.006 原发性胆汁性肝硬化 1(0.84) 1(0.26) 0.802 0.371 骨质疏松 26(21.85) 107(27.30) 1.407 0.236 压缩性骨折 3(2.52) 9(2.30) 0.020 0.887 冠心病 15(12.61) 28(7.14) 3.534 0.060 高血压 61(51.26) 164(41.84) 3.290 0.070 心力衰竭 1(0.84) 8(2.04) 0.760 0.383 脑梗死 22(18.49) 33(8.42) 9.636 0.002 慢性阻塞性肺疾病 4(3.36) 6(1.53) 1.595 0.207 支气管哮喘 0 2(0.51) 0.610 0.435 乙肝 1(0.84) 8(2.04) 0.760 0.383 贫血 64(53.78) 165(42.09) 5.044 0.025 2型糖尿病 26(21.85) 57(14.54) 3.584 0.058 甲减 2(1.68) 16(4.08) 1.548 0.213 甲亢 0 11(2.81) 3.413 0.065 颈椎病 3(2.52) 12(3.06) 0.094 0.760 腰椎间盘突出 18(15.13) 54(13.78) 0.138 0.711
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表 4 不同病程时间RA患者共患病的发生频次比较(例)
Table 4. Comparison of the frequency of comorbidity in RA patients of different disease course (cases)
共患病 <1年组
(n=84)1~3年组
(n=120)>3年组
(n=307)χ2值 P值 干燥综合征 1 4 16 2.628 0.245 强直性脊柱炎 0 0 1 1.109 0.717 骨关节病 12 24 50 1.446 0.481 间质性肺病 10 11 48 3.516 0.172 原发性胆汁性肝硬化 1 0 1 1.957 0.356 骨质疏松 6 19a 108ab 39.375 <0.001 椎体压缩性骨折 0 2 10 2.844 0.202 冠心病 5 8 30 1.945 0.378 高血压 36 38 151b 13.294 0.001 心力衰竭 1 2 6 0.162 0.911 脑梗死 8 4 43b 10.770 0.005 慢性阻塞性肺疾病 2 2 6 2.578 0.250 支气管哮喘 1 1 0 3.843 0.158 乙肝 3 1 5 2.134 0.356 贫血 34 52a 143ab 8.878 0.012 2型糖尿病 15 14 54 2.587 0.274 甲减 4 5 9 1.200 0.591 甲亢 0 5 6 3.761 0.124 颈椎病 2 4 9c 0.945 0.036 腰椎间盘突出 6 12a 54a 8.624 0.013 注：与<1年组比较, aP<0.05；与1~3年比较，bP<0.05。
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