类风湿关节炎患者下肢深静脉血栓发病率及危险因素

doi:10.19723/j.issn.1671-167X.2024.02.012

摘要/Abstract

摘要：

目的: 探讨类风湿关节炎(rheumatoid arthritis，RA)患者下肢深静脉血栓形成(deep vein thrombosis，DVT)的发病率及相关危险因素。方法: 回顾性分析航天中心医院风湿免疫科2015年5月至2021年9月住院RA患者的临床资料，包括人口学特征、伴随疾病、实验室检查(血常规、生化、凝血、炎症指标、类风湿因子、抗心磷脂抗体、狼疮抗凝物)及治疗方案等，并根据是否发生DVT将患者进行分组，应用t检验、Mann-Whitney U检验或卡方检验筛选RA患者发生DVT的相关因素，应用Logistic回归分析确定RA患者发生DVT的危险因素。结果: 共纳入RA患者322例，DVT发病率为9.6%(31/322)；DVT组患者的中位年龄、28个关节疾病活动度评分(disease activity score using 28 joints，DAS28)-红细胞沉降率(erythrocyte sedimentation rate，ESR)高于无DVT组[64(54，71)岁 vs. 50(25，75)岁，P＜0.001；5.2(4.5，6.7) vs. 4.5(4.5，5.0)，P＜0.001]；DVT组患者高血压、慢性肾脏病、3个月内骨折或手术史、下肢静脉曲张的发病率高于无DVT组(P均＜0.001)；DVT组血红蛋白、白蛋白水平低于无DVT组(P=0.009，P=0.004)，而D-二聚体水平及类风湿因子阳性率高于无DVT组(P＜0.001)；DVT组糖皮质激素的使用率高于无DVT组(P＜0.001)。Logistic回归分析显示，年龄(OR=1.093，P＜0.001)、慢性肾脏病(OR=7.955，P=0.005)、3个月内骨折或手术史(OR=34.658，P=0.002)、DAS28-ESR(OR=1.475，P=0.009)以及激素的使用(OR=5.916，P=0.003)是RA患者发生DVT的独立危险因素。结论: RA患者DVT发病率明显增高，除年龄、慢性肾脏病、3个月内骨折或手术史等传统危险因素外，DAS28-ESR增高和激素的使用也是RA患者发生DVT的独立危险因素。

关键词: 类风湿关节炎, 静脉血栓形成, 静脉血栓栓塞

Abstract:

Objective: To investigate the incidence and risk factors of deep vein thrombosis (DVT) in patients with rheumatoid arthritis (RA). Methods: The clinical data of RA patients who were hospi-talized in the Department of Rheumatology and Immunology of Aerospace Center Hospital from May 2015 to September 2021 was retrospectively analyzed, including demographic characteristics, concomitant diseases, laboratory examinations (blood routine, biochemistry, coagulation, inflammatory markers, rheumatoid factor, antiphospholipid antibodies and lupus anticoagulant, etc.) and treatment regimens. The patients were compared according to the presence or absence of DVT, and the t test, Mann-Whitney U test or Chi-square test were applied to screen for relevant factors for DVT, followed by Logistic regression analysis to determine risk factors for DVT in patients with RA. Results: The incidence of DVT in the RA patients was 9.6% (31/322); the median age of RA in DVT group was significantly older than that in non-DVT group [64 (54, 71) years vs. 50 (25, 75) years, P < 0.001]; the level of disease activity score using 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) in DVT group was higher than that in non-DVT group [5.2 (4.5, 6.7) vs. 4.5(4.5, 5.0), P < 0.001]; the incidence of hypertension, chronic kidney disease, fracture or surgery history within 3 months, and varicose veins of the lower extremities in DVT group was higher than that in non-DVT group (P < 0.001). The levels of hemoglobin and albumin in DVT group were significantly lower than that in non-DVT group (P=0.009, P=0.004), while the D-dimer level and rheumatoid factor positive rate in DVT group were significantly higher than that in non-DVT group (P < 0.001). The use rate of glucocorticoid in DVT group was higher than that in non-DVT group (P=0.009). Logistic regression analysis showed that the age (OR=1.093, P < 0.001), chronic kidney disease (OR=7.955, P=0.005), fracture or surgery history within 3 months (OR=34.658, P=0.002), DAS28-ESR (OR=1.475, P=0.009), and the use of glucocorticoid (OR=5.916, P=0.003) were independent risk factors for DVT in RA patients. Conclusion: The incidence of DVT in hospitalized RA patients was significantly increased, in addition to traditional factors, such as age and chronic kidney disease, increased DAS28-ESR level and the use of glucocorticoid were also independent risk factors for DVT.

Key words: Rheumatoid arthritis, Venous thrombosis, Venous thromboembolism

中图分类号:

R593.22

汤晓菲,李永红,丁秋玲,孙卓,张阳,王育梅,田美伊,刘坚. 类风湿关节炎患者下肢深静脉血栓发病率及危险因素[J]. 北京大学学报（医学版）, 2024, 56(2): 279-283.

Xiaofei TANG,Yonghong LI,Qiuling DING,Zhuo SUN,Yang ZHANG,Yumei WANG,Meiyi TIAN,Jian LIU. Incidence and risk factors of deep vein thrombosis in patients with rheumatoid arthritis[J]. Journal of Peking University (Health Sciences), 2024, 56(2): 279-283.

图/表 2

表1

RA合并与不合并DVT患者临床资料的比较"

Variables	RA (n=322)	RA with DVT (n=31)	RA without DVT (n=291)	P
Demographics
Age/years	65 (55, 73)	64 (54, 71)	50 (25, 75)	＜0.001
Female	263 (81.7)	25 (80.6)	238 (81.8)	0.876
Duration/months	84 (24, 216)	156 (12, 240)	84 (24, 204)	0.304
BMI/ (kg/m²)	23.4 (21.7, 24.8)	23.4 (19.5, 24.2)	23.4 (21.9, 24.8)	0.172
Smoke	53 (16.5)	8 (25.8)	45 (15.5)	0.140
Complication
Hypertension	129 (40.1)	22 (71.0)	107 (36.8)	＜0.001
Diabetes	54 (16.8)	5 (16.1)	49 (16.8)	0.920
CKD	14 (4.3)	6 (19.4)	8 (2.7)	＜0.001
CHD	45 (14.0)	5 (16.1)	40 (13.7)	0.927
Fracture or surgery	8 (2.5)	7 (22.6)	1 (0.3)	＜0.001
Malignancy	13 (4.0)	2 (6.5)	11 (3.8)	0.812
Varicose veins	7 (2.2)	3 (9.7)	4 (1.4)	0.022
APS	3 (0.9)	3 (9.7)	0	＜0.001
Laboratory data
Hemoglobin/(g/L)	112.0 (100.0, 123.0)	98.0 (86.0, 118.0)	113.0 (102.0, 124.0)	0.003
Albumin/(g/L)	35.6 (32.8, 38.3)	32.4 (30.1, 35.9)	35.6 (33.3, 38.5)	＜0.001
D-dimer/(μg/L)	405.5 (181.8, 838.5)	831.0 (528.0, 1 731.0)	367.0 (167.0, 798.0)	＜0.001
CRP/(mg/L)	15.1 (5.6, 41.1)	13.5 (5.5, 53.0)	15.3 (5.7, 40.5)	0.919
ESR/(mm/h)	43.5 (22.0, 70.0)	51.0 (22.0, 90.0)	43.0 (22.0, 68.0)	0.256
IgG/(mg/dL)	1 355.0 (1 087.5, 1 062.5)	1 340.0 (1 050.0, 1 490.0)	1 360.0 (1 110.0, 1 610.0)	0.548
RF	255 (79.2)	29 (93.5)	226 (77.7)	0.038
Anti-CCP	255 (79.2)	25 (80.6)	230 (79.0)	0.834
ACA	24 (7.5)	3 (9.7)	21 (7.2)	0.892
Anti-β2-GP1	22 (6.8)	4 (12.9)	18 (6.2)	0.301
LAC	8 (2.5)	1 (3.2)	7 (2.4)	0.559
DAS28-ESR	4.5 (4.5, 5.8)	5.2 (4.5, 6.7)	4.5 (4.5, 5.0)	0.036
Therapy
Glucocorticoid	149 (46.3)	25 (80.6)	124 (42.6)	＜0.001
JAK inhibitors	11 (3.4)	0	11 (3.8)	0.561
MTX	138 (42.9)	12 (18.7)	126 (43.3)	0.624
LEF	112 (34.8)	13 (41.9)	99 (34.0)	0.379
HCQ	47 (14.6)	4 (12.9)	43 (14.8)	0.989

表1

表2

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