类风湿关节炎合并角膜溃疡的临床特点和相关因素分析

doi:10.19723/j.issn.1671-167X.2021.06.004

摘要/Abstract

摘要：

目的:探讨类风湿关节炎(rheumatoid arthritis,RA)合并角膜溃疡(ulcerative keratitis,UK)的临床特点、相关因素及临床转归。方法:选取2003年1月至2021年5月于北京大学人民医院住院的RA患者4 773例,筛选出合并UK的患者16例(UK组),通过倾向性评分匹配(propensity score matching,PSM), 选取无UK的对照组患者72例。对PSM后的两组患者的临床及实验室资料进行统计和分析。结果:RA合并UK表现为单纯边缘性UK 8例、边缘性UK伴穿孔5例、边缘性UK伴葡萄膜炎2例、中央性UK伴穿孔1例。UK组肿胀关节数显著高于对照组[6.0(2.5,23.0) vs. 3.0(1.0, 9.8),Z=-2.047,P=0.041],UK组继发干燥综合征(Sjögren syndrome,SS)的比例(37.5% vs. 6.9%, χ²=11.175,P=0.004)及间质性肺炎(interstitial lung disease,ILD,37.5% vs. 8.3%, χ²=9.456,P=0.008)的比例显著高于对照组,柳氮磺吡啶(12.5% vs. 48.6%, χ²=7.006,P=0.008)、来氟米特(31.3% vs. 63.9%, χ²=5.723,P=0.017)及金制剂(6.3% vs. 33.8%, χ²=4.841,P=0.032)的使用率显著低于对照组。回归分析显示肿胀关节数(OR=1.148)、继发SS(OR=79.118)、合并ILD(OR=6.596)及柳氮磺吡啶的使用(OR=0.037)与RA合并UK的发生存在独立相关性(P<0.05)。结论:UK为RA的少见并发症,多为边缘性UK。肿胀关节数、继发SS、合并ILD及柳氮磺吡啶的使用与RA合并UK发生存在独立相关性。

关键词: 类风湿关节炎, 角膜溃疡, 相关因素

Abstract:

Objective: To investigate the clinical characteristics, risk factors and prognosis of ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). Methods: Sixteen patients with UK (the UK group) were screened among 4 773 RA patients hospitalized at Peking University People’s Hospital from January 2003 to May 2021, and 72 patients with RA without UK in the control group were selected by propensity score matching (PSM). The clinical features, laboratory data and medications between the two groups were collected and analyzed. Results: The average age of the patients with RA was 60 years at the time of the complication of UK. UK appeared on average in the 16th year of RA, with the majority of UK occurring in the 7th year of RA and beyond (14 cases), however, a minority of UK was the first symptom of RA (1 case). UK associated with RA manifested as simple marginal UK in 8 cases, marginal UK with perforation in 5 cases, marginal UK with uveitis in 2 cases and central UK with perforation in 1 case. The number of swollen joints was significantly higher in the UK group than in the control group [6.0(2.5,23.0) vs. 3.0(1.0, 9.8), Z=-2.047, P=0.041], and the proportion of secondary Sjögren syndrome (SS,37.5% vs. 6.9%, χ²=11.175, P=0.004) and interstitial lung disease (ILD, 37.5% vs. 8.3%, χ ²=9.456, P=0.008) were significantly higher in the RA patients with UK than the patients without UK. The uses of sulfasalazine (12.5% vs. 48.6%, χ ²=7.006, P=0.008), leflunomide (31.3% vs. 63.9%, χ ²=5.723, P=0.017) and gold salt(6.3% vs. 33.8%, χ ²=4.841, P=0.032)were significantly lower in the UK group than in the control group. However, there was no statistically significant comparison between the two groups for the 28-joint disease activity score-erythrocyte sedimentation rate (5.3±1.8 vs. 5.1±1.6, t=0.309, P=0.761). Logistic analysis showed the number of swollen joints (OR=1.148), secondary SS (OR=79.118), complicated with ILD (OR=6.596) and the use of sulfasalazine (OR=0.037) were independent relevant factors (P<0.05) for UK in RA patients. Conclusion: The number of swollen joints, secondary SS, complicated with ILD and the use of sulfasalazine are independent relevant factors for UK in patients with RA.

Key words: Rheumatoid arthritis, Ulcerative keratitis, Relevant factor

中图分类号:

R593.22

罗靓,霍文岗,张钦,李春. 类风湿关节炎合并角膜溃疡的临床特点和相关因素分析[J]. 北京大学学报（医学版）, 2021, 53(6): 1032-1036.

LUO Liang,HUO Wen-gang,ZHANG Qin,LI Chun. Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis[J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1032-1036.

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Items	UK group (n=16)	Control group (n=72)	Z/t/χ²	P
ESR/(mm/H), $\overline{x}$±s	57.4±38.3	50.3±30.7	0.839	0.404
CRP/(mg/L), M (P₂₅, P₇₅)	15.8 (5.4, 42.3)	11.2 (3.2, 38.6)	-0.155	0.877
Anti-CCP/(U/mL), M (P₂₅, P₇₅)	303.0 (97.5, 650.0)	100.0 (33.3, 300.0)	-0.879	0.379
RF/(IU/mL), M (P₂₅, P₇₅)	222.0 (144.2, 266.4)	125.5 (18.5, 293.8)	-1.862	0.063
TJCs, M (P₂₅, P₇₅)	7.0 (1.0, 16.5)	7.0 (2.0, 15.8)	-0.836	0.836
DJCs, M (P₂₅, P₇₅)	1.5 (0, 10.0)	0 (0, 4.0)	-1.899	0.058
SJCs, M (P₂₅, P₇₅)	6.0 (2.5, 23.0)	3.0 (1.0, 9.8)	-2.047	0.041
Secondary SS, n (%)	6 (37.5)	5 (6.9)	11.175	0.004
DAS28-ESR score, $\overline{x}$±s	5.3±1.8	5.1±1.6	0.309	0.761
Complicated with ILD, n (%)	6 (37.5)	6 (8.3)	9.456	0.008
Rheumatoid nodules, n (%)	3 (18.8)	3 (4.2)	4.382	0.122

Parameters	UK group (n=16)	Control group (n=72)	χ²	P
HCQ/%	25.0	59.7	1.304	0.392
MTX/%	37.5	56.9	0.166	0.784
SASP/%	12.5	48.6	7.006	0.008
GS/%	6.3	33.8	4.841	0.032
LEF/%	31.3	63.9	5.723	0.017
GC/%	31.3	54.2	1.135	0.404
Biologics/%	6.3	81.9	1.364	0.450
Untreated/%	43.8	25.0	2.263	0.218

Parameters	B	Wald	P	OR	95%CI
SJCs	0.138	5.875	0.015	1.148	1.027-1.284
Secondary SS	4.371	8.333	0.004	79.118	4.068-1 538.736
ILD	1.886	4.230	0.040	6.596	1.093-39.813
SASP	-3.288	4.494	0.034	0.037	0.002-0.780
LEF	-1.696	2.485	0.115	0.183	0.022-1.511
GS	-1.219	0.567	0.623	0.451	0.012-7.042