北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (6): 1034-1039. doi: 10.19723/j.issn.1671-167X.2020.06.008
张璐1,胡小红2,王庆文1,蔡月明1,赵金霞3,△(),刘湘源3,△()
Lu ZHANG1,Xiao-hong HU2,Qing-wen WANG1,Yue-ming CAI1,Jin-xia ZHAO3,△(),Xiang-yuan LIU3,△()
摘要:
目的:研究类风湿关节炎(rheumatoid arthritis, RA)患者中颈椎失稳人群构成情况,分析RA合并颈椎失稳患者的临床特征。方法:纳入2015年8月至2019年3月于北京大学深圳医院以及北京大学第三医院风湿免疫科就诊并进行了颈椎X线片检查的RA患者共439例,收集患者的临床和实验室资料以及颈椎影像学资料并进行分析。统计纳入RA患者中颈椎失稳患者占总人群的构成比以及不同类型颈椎失稳患者占比情况,并使用t检验、秩和检验、卡方检验等方式比较颈椎失稳RA患者和无颈椎失稳RA患者的临床资料,分析RA患者颈椎失稳人群的临床特点。结果:439位患者中男性84例,占总人数19.1%;女性355例,占总人数80.9%。患者平均年龄(52.9±13.9)岁。病程中位数60个月,病史最短2周,最长46年。合并颈椎失稳者有130例,占29.6%(130/439),其中寰枢关节向前半脱位(anterior atlantoaxial subluxation, AAS)占24.6% (108/439),齿状突垂直半脱位(vertical subluxation, VS)占7.3% (32/439),下段颈椎半脱位(subaxial subluxations, SAS)占2.3%(10/439),130例中有20例同时合并2种不同类型颈椎失稳。与无颈椎受累组患者相比,颈椎失稳组患者病程长[120(36,240)个月vs. 48(12,120)个月]、外周关节畸形比例高(56.9% vs.29.9%)、患者总体视觉模拟评分法(visual analogue scale, VAS)评分高(4.89±2.49 vs.3.93±2.38)、血红蛋白含量低[(111.31±19.44) g/L vs.(115.56±16.60) g/L],抗环瓜氨酸多肽(cyclic-citrullinated peptide, CCP)抗体阳性率高(90.8% vs. 76.6%)。两组患者在性别、年龄、肿胀关节数、压痛关节数、红细胞沉降率、类风湿因子水平、28个关节疾病活动度评分、抗角蛋白抗体阳性率、糖皮质激素和改善病情抗风湿药用药史上的差异无统计学意义。结论:本研究中29.6%的RA患者合并颈椎失稳;RA颈椎失稳人群具有病程长、外周关节畸形比例高、患者总体VAS评分高、血红蛋白含量低及抗CCP抗体阳性率高的临床特点。
中图分类号:
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