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北京大学学报（医学版） ›› 2018, Vol. 50 ›› Issue (6): 1044-1048. doi: 10.19723/j.issn.1671-167X.2018.06.018

• 论著 • 上一篇    下一篇

骨关节炎患者用药治疗现状的全国多中心大样本现场调查

张晓盈1,彭嘉婧1,刘传慧2,蔡小燕3,张江林4,梅轶芳5,靳洪涛6,王晓非7,磨红8,栗占国1,△()   

  1. 1. 北京大学人民医院风湿免疫科,北京 100044
    2. 郑州市骨科医院风湿免疫科,郑州　450052
    3. 广州市第一人民医院风湿免疫科,广州　510180
    4. 中国人民解放军总医院风湿免疫科,北京　100039
    5. 哈尔滨医科大学附属第一医院风湿免疫科, 哈尔滨　150001
    6. 河北医科大学第二医院风湿免疫科,石家庄　050000
    7. 中国医科大学附属盛京医院风湿免疫科,沈阳　110004
    8. 南宁市第一人民医院风湿免疫科,南宁　530022
  • 收稿日期:2018-08-04 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 栗占国 E-mail:li99@bjmu.edu.cn

A multi-center cross-sectional survey of medicine application in patients with osteoarthritis in China

Xiao-ying ZHANG1,Jia-jing PENG1,Chuan-hui LIU2,Xiao-yan CAI3,Jiang-lin ZHANG4,Yi-fang MEI5,Hong-tao JIN6,Xiao-fei WANG7,Hong MO8,Zhan-guo LI1,△()   

  1. 1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Zhengzhou Orthopaedics Hospital, Zhengzhou 450052, China
    3. Department of Rheumatology and Immunology, Guangzhou First People’s Hospital, Guangzhou 510180, China
    4. Department of Rheumatology and Immunology, Chinese PLA General Hospital, Beijing 100039, China
    5. Department of Rheumatology and Immunology, The First Hospital of Harbin Medical University, Harbin 150001, China
    6. Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
    7. Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang 110004, China
    8. Department of Rheumatology and Immunology, Nanning First People’s Hospital, Nanning 530022, China
  • Received:2018-08-04 Online:2018-12-18 Published:2018-12-18
  • Contact: Zhan-guo LI E-mail:li99@bjmu.edu.cn

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摘要：

目的: 目的:评估骨关节炎在我国患病及用药现况,并进行疾病评估。方法: 采用流行病学现场调查的研究方法,对2017年4—10月全国40家医院1 066例骨关节炎患者的一般资料、患病情况、用药情况以及关节功能进行评估。数据采用SPSS 19.0软件进行统计学处理,采用t检验、Mann-Whitney U检验、卡方检验对数据进行分析。结果: 本组1 066例患者中,男、女比例为1 :3.6,平均年龄(61.9±11.0)岁,年龄分布于36~94岁。膝骨关节炎、髋骨关节炎、手骨关节炎患病人数分别是873例(81.9%)、150例(14.1%)、387例(36.3%),其中合并两个部位的患者242例(22.7%),3 个部位均受累关节炎患者为51例(4.8%)。56.6%(603/1 066)患者应用过1种及以上非甾体抗炎药,28.9%(308/1 066)患者应用1种及以上止痛药物。61.2%(652/1 066)应用1种及以上改善病情骨关节炎药,包括氨基葡萄糖(400/1 066,37.5%)、硫酸软骨素(21/1 066,2.0%)、双醋瑞因(63/1 066,5.9%)或联合应用2种以上改善病情骨关节炎药(168/1 066,15.8%)。92例(8.6%)患者应用止痛药控制症状,未进一步使用抗炎及保护关节药物。232例(21.8%)患者应用关节腔穿刺注射药物,应用玻璃酸钠或糖皮质激素分别为98例(9.2%)和48例(4.5%), 而将二者联合应用达86例(8.1%)。应用局部外用药物患者占26.5%(283/1 066), 理疗占15.8%(168/1 066)。与膝关节受累患者相比,髋关节受累患者的病情明显更加严重,两组患者按照美国西部安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分评估疼痛(Z=-7.625,P<0.001)、僵硬感(Z=-6.229,P<0.001)、关节功能(Z=-6.777,P<0.001),差异均有统计学意义,并且髋骨关节炎患者更多应用止痛药物(χ 2=24.838,P<0.001)。 结论: 我国骨关节炎患者以口服非甾体抗炎药及改善病情骨关节炎药为主要治疗方式,但存在药物使用不规范情况;与膝骨关节炎相比,髋骨关节炎患者病情更为严重,需引起重视,并积极治疗。

关键词: 骨关节炎, 治疗药物, 现场调查

Abstract:

Objective: To investigate the clinical characteristics, the medicine application and to eva-luate the disease activity in patients with osteoarthritis (OA) in China.Methods:This was a cross-sectional study. Totally 1 066 cases of OA from 40 hospitals in China from April to October 2017 were retrospectively enrolled. Demographic characteristics, clinical data, medicine application, and joint function were evaluated. All the data were analyzed by SPSS software 19.0. t test, Mann-Whitney U test and chi-square test were used for statistical analysis.Results:In the 1 066 cases, the male-to-female ratio was 1 :3.6 and the average age was (61.9±11.0) years, with an age range from 36 to 94 years. The incidence of knee OA, hip OA, and hand OA were respectively 81.9% (873/1 066), 14.1% (150/1 066), and 36.3% (387/1 066). In the study, 242 (22.7%) cases had two kinds of joint areas involved and three joint areas were involved in 51 cases (4.8%), and 56.6% (603/1 066) of the patients used more than one kind of non- steroid anti-inflammatory drugs (NSAIDs) while 61.2% (652/1 066) used disease modifying osteoarthritis drugs (DMOADs), including glucosamine (37.5%, 400/1 066), chondroitin sulfate (2.0%, 21/1 066), diacetate (5.9%, 63/1 066), and the combination of these drugs (15.8%, 168/1 066). 8.6% (92/1 066) patients only took analgesics to relieve the pain, not using any kind of NSAIDs or DMOADs. And 232 patients (21.7%) had intra-articular injections, including 9.2% (98/1 066) sodium hyaluronate, 4.5%(48/1 066) glucocorticoid, and 8.1% (86/1 066) combination of the two drugs. The proportion of the patients taking topical drugs accounted for 26.5% (283/1 066) and physical therapy accounted for 15.8% (168/1 066). Compared with those who suffered from knee OA, the patients who suffered from hip OA had more severe disease assessment. Moreover, there were significant differences in pain (Z=-7.625, P<0.001), morning stiffness (Z=-6.229, P<0.001), and joint function (Z=-6.777, P<0.001) between the two groups of the patients who suffered from knee or hip OA with The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Furthermore, patients with hip OA took more analgesics (χ 2=24.838, P<0.001). Conclusion:Oral NSAIDs and DMOADs are wildly used in patients with OA in China. However, the treatment of some patients still need to be improved. Patients with hip OA are more seriously ill and require aggressive treatment.

Key words: Osteoarthritis, Drug therapy, Cross-sectional study

中图分类号: 

  • R593

表1

1 066例骨关节炎患者人口学资料"

Items Patients, n(%)
Gender
Female 836 (78.4)
Male 230 (21.6)
Age/years
<45 51 (4.8)
45-<60 402 (37.7)
60-<80 536 (50.3)
≥80 75 (7.0)
Body mass index/(kg/m2)
<18.5 42 (3.9)
18.5-<25.0 561 (52.6)
25.0-<30.0 367 (34.4)
≥30.0 69 (6.5)
Duration/months
<12 225 (21.1)
12-<60 364 (34.1)
60-<120 209 (19.6)
≥120 257 (24.1)
Smoking status
Never smoked 932 (87.4)
Current smoker 80 (7.5)
Ex-smoker 42 (3.9)
Family history
Yes 104 (9.8)
None 944 (88.6)

表2

1 066例骨关节炎患者治疗情况"

Therapeutics Patients, n(%)
NSAIDs 603 (56.6)
Analgesic 308 (28.9)
DMOADs
Glucosamine 400 (37.5)
Chondroitin 21 (2.0)
Diacerein 63 (5.9)
Combined 2 DMOADs or more 168 (15.8)
Surgical
Arthroplasty 14 (1.3)
Arthroscopy 17 (1.6)
Intra-articular injections
Glucocorticoid 48 (4.5)
Hyaluronate 98 (9.2)
Combined 86 (8.1)
Topical medications 283 (26.5)
Physical therapy 168 (15.8)

表3

909例膝、髋骨关节炎患者临床特征分析"

Items Knee OA group (n=759) Hip OA group (n=150) t/Z/χ2 P value
Female, n(%) 602 (73.9) 113 (75.3) 1.183 0.277
Age/years, x-±s 61.4±10.8 65.1±12.2 -3.486 0.001
BMI/(kg/m2), x-±s 24.4±3.4 24.0±3.9 1.284 0.201
Duration/months, median (IQR) 36 (12,108) 60 (22.5,120.0) -2.847 0.004
Assessment from patients/cm, median (IQR) 5 (3,7) 6.0 (4.0,7.1) -4.374 <0.001
Assessment fromphysicians/cm, median (IQR) 5 (3,6) 5.25 (4.0,7.0) -4.719 <0.001
WOMAC score, median (IQR)
Pain 30.0 (11.8,46.0) 48.0 (30.0,63.5) -7.625 <0.001
Stiffness 20.0 (7.5,40.0) 37.5 (20.0,55.0) -6.229 <0.001
Function 28.2 (11.8,49.3) 45.9 (30.3,60.6) -6.777 <0.001
Treatment, patients
NSAIDs, n(%) 414 (54.5) 94 (62.7) 3.351 0.067
Analgesic, n(%) 204 (26.8) 71 (47.3) 24.838 <0.001
DMOADs, n(%) 474 (62.5) 96 (64.0) 0.129 0.720
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ISSN 1671-167X
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