类风湿关节炎合并颈椎失稳的人群分布及临床特征

doi:10.19723/j.issn.1671-167X.2020.06.008

摘要/Abstract

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。

关键词: 类风湿关节炎, 颈椎失稳, 外周关节畸形, 抗环瓜氨酸多肽抗体

Abstract:

Objective: To investigate the population distribution of cervical spine instability in rheumatoid arthritis (RA) patients, and to analyze the clinical characteristics in RA patients with cervical spine instability. Methods: A total of 439 RA patients who had completed cervical spine X-ray examination from Department of Rheumatology and Immunology of Peking University Shenzhen Hospital and Peking University Third Hospital from August 2015 to March 2019 were enrolled. The clinical data, laboratory data and cervical radiographic data were collected and analyzed by t-test, rank sum test and Chi-square test to clarify the clinical characteristics in the RA patients with cervical spine instability. Results: Of the 439 RA patients, 80.9% (355/439) were female, with an average age of (52.9±13.9) years, a median duration of the disease was 60 months, the shortest history was 2 weeks, and the longest history was up to 46 years. 29.6% (130/439) of the RA patients showed cervical spine instability. Among them, 20 RA patients were complicated with two different types of cervical instability, the atlantoaxial subluxation (AAS) accounted for 24.6% (108/439), the vertical subluxation (VS) accounted for 7.3% (32/439) and the subluxial subluxations (SAS) accounted for 2.3% (10/439). The patients with cervical spine instability had a longer duration of disease [120 (36, 240) months vs. 48 (12, 120) months], a higher proportion of peripheral joint deformity (56.9% vs. 29.9%), and a higher visual analog scale (VAS) measuring general health score (4.89±2.49 vs. 3.93±2.38), a lower hemoglobin [(111.31±19.44) g/L vs. (115.56±16.60) g/L] and a higher positive rate of anti-cyclic citrullina-ted peptide (CCP) antibody (90.8% vs. 76.6%). There were no significant differences in gender, age, number of swollen joints, number of tenderness joints, erythrocyte sedimentation rate, rheumatoid factor level, 28-joint disease activity score, positive rate of anti keratin antibody, duration of glucocorticoid use and duration of disease modifying anti-rheumatic drugs use between the two groups. Conclusion: In the study, 29.6% of the RA patients showed cervical spine instability. RA patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity, a higher VAS measuring general health score, a lower hemoglobin and a higher positive rate of anti-CCP antibody.

Key words: Rheumatoid arthritis, Cervical spine instability, Peripheral joint deformity, Anti-cyclic citrullinated peptide

中图分类号:

R783.2

张璐,胡小红,王庆文,蔡月明,赵金霞,刘湘源. 类风湿关节炎合并颈椎失稳的人群分布及临床特征[J]. 北京大学学报（医学版）, 2020, 52(6): 1034-1039.

Lu ZHANG,Xiao-hong HU,Qing-wen WANG,Yue-ming CAI,Jin-xia ZHAO,Xiang-yuan LIU. Population distribution and clinical characteristics in rheumatoid arthritis patients with cervical spine instability[J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1034-1039.

图/表 1

表1

参考文献 29

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Items	Cervical spine instability group (n=130)	None cervical spine instability group (n=309)	P
Female,n(%)	107 (82.3)	248 (80.3)	0.816
Age/years, $x - ± s$	52.03±13.76	53.33±13.94	0.624
Duration of disease/months, M(P₂₅, P₇₅)	120 (36, 240)	48 (12, 120)	<0.001
Swollen joints, M(P₂₅, P₇₅)	3 (1, 9)	2 (0, 8)	0.237
Tender joints, M(P₂₅, P₇₅)	5 (1,13)	4 (1,12)	0.575
Peripheral joint malformations, n(%)	74 (56.9)	92 (29.9)	<0.001
VAS measuring general health score, $x - ± s$	4.89±2.49	3.93±2.38	<0.001
DAS28-ESR score, M(P₂₅, P₇₅)	4.89 (3.46, 6.14)	4.38 (3.03, 5.90)	0.099
Anti-CCP positive, n(%)	108 (90.8)	226 (76.6)	0.001
RF positive, n(%)	101 (80.8)	226 (75.1)	0.203
AKA positive, n(%)	17 (15.3)	34 (12.5)	0.454
ANA positive, n(%)	65 (53.7)	146 (51.4)	0.670
High CRP levels, n(%)	85 (68.5)	187 (63.8)	0.354
ESR/(mm/H), M(P₂₅, P₇₅)	30.0 (16.0, 58.0)	30.0 (16.0, 57.3)	0.374
WBC/(×10⁹/L), $x - ± s$	6.30±2.36	6.54±2.43	0.439
HGB/(g/L), $x - ± s$	111.31±19.44	115.56±16.60	0.021
PLT(×10⁹/L), $x - ± s$	280.94±103.61	284.14±95.77	0.987
Glucocorticoids usage longer than 6 months, n(%)	75 (59.5)	148 (50.7)	0.096
cDMARDs usage more the 3 months, n(%)	91 (73.4)	212 (74.1)	0.876
bDMARDs usage, n(%)	110 (86.6)	268 (89.3)	0.420