低疾病活动度的中轴型脊柱关节炎患者残留症状评估及其相关因素分析

doi:10.19723/j.issn.1671-167X.2024.06.007

摘要/Abstract

摘要：

目的: 评估达到低疾病活动度(low disease activity，LDA)的中轴型脊柱关节炎(axial spondyloarthritis，ax-SpA)患者的残留症状发生情况，并对相关因素进行分析。方法: 对2021年5月1日至2024年2月29日于北京大学第三医院风湿免疫科就诊的首次达到LDA的ax-SpA患者的病例资料进行分析，根据强直性脊柱炎疾病活动评分-C反应蛋白(ankylosing spondylitis disease activity score-C-reactive protein，ASDAS-CRP)，将达到LDA的患者分为达到LDA但未缓解组和缓解组，评估两组患者残留疲劳及疼痛症状的发生情况，并采用二元Logistic回归分析其相关因素。结果: 在治疗过程中首次达到LDA的患者201例，包括男性151例(75.1%)、女性50例(24.9%)，中位年龄32.0(28.0，37.0)岁，中位病程6.7(3.8，11.5)年, 其中达到LDA但未缓解组140例(69.7%)、缓解组61例(30.3%)。残留疲劳视觉模拟评分(visual analogue scale，VAS)≥4分患者92例(45.8%)，其中达到LDA但未缓解组残留疲劳VAS≥4分的患者比例明显高于缓解组(53.6% vs. 27.9%，P=0.001)；残留疼痛VAS≥4分的患者49例(24.4%)，其中达到LDA但未缓解组残留疼痛VAS≥4分比例亦明显高于缓解组(30.0% vs. 11.5%，P=0.005)。二元Logistic回归分析发现，CRP水平对于残留疲劳症状有显著的负性影响(B=-0.142，P=0.008，OR=0.868)，国际脊柱关节炎评估协会-健康指数(Assessment of Spondyloarthritis International Society-health index，ASAS-HI)对于残留疲劳症状有显著的正性影响(B=0.288，P＜0.001，OR=1.334)；性别对于残留疼痛症状有显著影响，女性的残留疼痛症状风险更高(B=1.135，P=0.002，OR=3.112)。结论: 残留疲劳和疼痛症状在达到LDA的ax-SpA患者中常见，尤其是女性患者；未来需要更多地关注和评估残留疾病负担，优化治疗方案。

关键词: 中轴型脊柱关节炎, 疾病活动度, 疼痛, 疲劳, 相关因素

Abstract:

Objective: To comprehensively assess the occurrence of residual symptoms in patients with axial spondyloarthritis who have successfully attained the treatment goal of low disease activity, and to conduct a thorough analysis of the related factors. Methods: An analysis was performed on axial spondyloarthritis patients who achieved low disease activity for the first time during their visits at the Rheumatology and Immunology Department of Peking University Third Hospital, spanning from May 1, 2021, to February 29, 2024. Based on the ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP), the patients who achieved low disease activity were divided into a non-remission low disease activity group and a remission group. The occurrence of residual fatigue and pain symptoms in both groups was assessed, and binary Logistic regression analysis was used to evaluate the related factors. Results: In the study, 201 patients achieved low disease activity during treatment. The gender distribution was skewed towards males, with 151 male patients (75.1%) and 50 female patients (24.9%). The median age of the patients who achieved low disease activity was 32.0 (28.0, 37.0) years, and the median disease duration was 6.7 (3.8, 11.5) years. Notably, 140 patients (69.7%) achieved low disease activity but did not experience complete remission, while 61 patients (30.3%) attained remission. A substantial proportion of the patients, 45.8%, reported residual fatigue visual analogue scale (VAS) ≥4, with a marked difference between the non-remission low disease activity group and the remission group (53.6% vs. 27.9%, P=0.001). Similarly, 24.4% of the patients had residual pain VAS ≥4, with a significant disparity between the non-remission low disease activity group and the remission group (30.0% vs. 11.5%, P=0.005). Binary Logistic regression analysis revealed that C-reactive protein levels had a notable negative influence on residual fatigue symptom (B=-0.142, P=0.008, OR=0.868), whereas ASAS-HI had a positive effect on residual fatigue (B=0.288, P < 0.001, OR=1.334). Gender was found to have a significant impact on residual pain symptoms, with females exhibiting a higher risk (B=1.135, P=0.002, OR=3.112). Conclusion: The residual fatigue and pain symptoms are common in axial spondyloarthritis patients who have achieved low disease activity, particularly among female patients. More assessment and recognition of the residual disease burden in these patients will be needed to optimize the treatment strategies.

Key words: Axial spondyloarthritis, Disease activity, Pain, Fatigue, Related factors

中图分类号:

R593.2

翟佳羽, 赵金霞, 安卓, 刘蕊. 低疾病活动度的中轴型脊柱关节炎患者残留症状评估及其相关因素分析[J]. 北京大学学报（医学版）, 2024, 56(6): 987-993.

Jiayu ZHAI, Jinxia ZHAO, Zhuo AN, Rui LIU. Assessment of residual symptoms in patients with axial spondyloarthritis with low disease activity and analysis of its related factors[J]. Journal of Peking University (Health Sciences), 2024, 56(6): 987-993.

图/表 5

表1

达到未缓解LDA和缓解患者的临床特征比较"

Items	Total LDA (ASDAS-CRP＜2.1) (n=201)	Remission (ASDAS-CRP＜1.3) (n=61)	Non-remission LDA (1.3≤ASDAS-CRP＜2.1) (n=140)	Z/χ²	P
Male, n(%)	151 (75.1)	46 (75.4)	105 (75.0)	0.004	0.951
Age/years, M(P₂₅, P₇₅)	32.0 (28.0, 37.0)	30.0 (26.5, 36.0)	33.0 (28.3, 37.0)	-1.708	0.088
Symptom duration/years, M(P₂₅, P₇₅)	6.7 (3.8, 11.5)	6.8 (3.8, 10.5)	6.5 (3.8, 11.9)	-0.334	0.739
Higher education^a, n(%)	163 (81.1)	56 (91.8)	107 (76.4)	6.551	0.010
BMI≥24 kg/m², n(%)	86 (42.8)	20 (32.8)	66 (47.1)	3.577	0.059
Positive HLA-B27, n(%)	169 (84.1)	50 (82.0)	119 (85.0)	0.292	0.589
History of EMMs, n(%)
Uveitis	46 (22.9)	13 (21.3)	33 (23.6)	0.123	0.726
IBD	3 (1.5)	1 (1.6)	2 (1.4)	0.013	0.910
PsO	5 (2.5)	2 (3.3)	3 (2.1)	0.226	0.635
Smoking, n(%)				1.375	0.241
Never	147 (73.1)	48 (78.7)	99 (70.7)
Occasional	11 (5.5)	0	11 (7.9)
Frequent	21 (10.4)	6 (9.8)	15 (10.7)
Second hand	7 (3.5)	2 (3.3)	5 (3.6)
Former	15 (7.5)	5 (8.2)	10 (7.1)
Medication use, n(%)
NSAIDs	147 (73.1)	36 (59.0)	111 (79.3)	8.884	0.003
csDMARDs	37 (18.4)	10 (16.4)	27 (19.3)	0.237	0.627
TNF inhibitor	77 (38.3)	29 (47.5)	48 (34.3)	3.159	0.076
IL-17 inhibitor	35 (17.4)	11 (18.0)	24 (17.1)	0.023	0.878
ASDAS, M(P₂₅, P₇₅)	1.5 (1.2, 1.8)	1.0 (0.7, 1.1)	1.7 (1.5, 1.9)	-11.299	＜0.001
BASDAI, M(P₂₅, P₇₅)	1.6 (1.0, 2.4)	1.0(0.5, 1.8)	2.0 (1.2, 2.6)	-5.109	＜0.001
BASFI, M(P₂₅, P₇₅)	0.6 (0.1, 1.2)	0.3 (0.0, 0.9)	0.8 (0.2, 1.3)	-2.912	0.004
ASAS-HI, M(P₂₅, P₇₅)	2 (0, 4)	1 (0, 2)	2 (1, 4)	-2.992	0.003
CRP/(mg/L)，M(P₂₅, P₇₅)	2.9 (1.8, 6.1)	1.9 (1.2, 2.7)	4.9 (2.1, 7.0)	-6.622	＜0.001
Fatigue VAS≥4, n(%)	92 (45.8)	17 (27.9)	75 (53.6)	11.308	0.001
Pain VAS≥4, n(%)	49 (24.4)	7 (11.5)	42 (30.0)	7.909	0.005
ASAS-HI＞5, n(%)	38 (18.9)	8 (13.1)	30 (21.4)	1.916	0.166

表1

表2

表3

表4

表5

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Items	Fatigue VAS＜4 (n=109)	Fatigue VAS≥4 (n=92)	Z/χ²	P
Sex, n(%)			7.062	0.008
Male	90 (82.6)	61 (66.3)
Female	19 (17.4)	31 (33.7)
Age/years, M(P₂₅, P₇₅)	33.0 (28.0, 37.0)	32.0 (27.0, 36.0)	-1.064	0.287
Symptom duration/years, M(P₂₅, P₇₅)	7.0 (3.9, 11.4)	6.0 (3.8, 11.6)	-0.651	0.515
History of EMMs, n(%)
Uveitis	20 (18.3)	26 (28.3)	2.778	0.096
IBD	2 (1.8)	1 (1.1)	0.190	0.663
PsO	2 (1.8)	3 (3.3)	0.418	0.518
Smoking, n(%)			1.749	0.782
Never	80 (73.4)	67 (72.8)
Occasional	5 (4.6)	6 (6.5)
Frequent	10 (9.2)	11 (12.0)
Secondhand	5(4.6)	2 (2.2)
Former	9 (8.3)	6 (6.5)
Medication use, n(%)
NSAIDs	79 (72.5)	68 (73.9)	0.052	0.819
csDMARDS	25 (22.9)	12 (13.0)	3.251	0.071
TNF inhibitor	40 (36.7)	37 (40.2)	0.262	0.609
IL-17 inhibitor	18 (16.5)	17 (18.5)	0.134	0.714
BASFI, M (P₂₅, P₇₅)	0.4 (0.0, 1.1)	0.7 (0.2, 1.5)	-2.001	0.045
ASAS-HI, M (P₂₅, P₇₅)	1.0 (0.0, 3.0)	3.0 (1.0, 5.0)	-4.981	0.000
CRP/(mg/L), M (P₂₅, P₇₅)	4.1 (1.9, 7.0)	2.3 (1.6, 5.0)	-2.777	0.005

Items	B	S.E.	Wald	P	OR (95%CI)
Sex (Female)	0.581	0.371	2.450	0.118	1.787 (0.864-3.697)
CRP	-0.142	0.053	7.070	0.008	0.868 (0.782-0.963)
BASFI	0.012	0.222	0.003	0.956	1.012 (0.655-1.566)
ASAS-HI	0.288	0.080	12.989	＜0.001	1.334 (1.141-1.561)
Constant	-0.425	0.340	1.564	0.211	0.654

Items	Pain VAS＜4 (n=152)	Pain VAS≥4 (n=49)	Z/χ²	P
Sex, n (%)			8.811	0.003
Male	122 (80.3)	29 (59.2)
Female	30 (19.7)	20 (40.8)
Age/years, M (P₂₅, P₇₅)	32.0 (28.0, 37.0)	32.0 (26.5, 37.0)	-2.557	0.011
Symptom duration/years, M (P₂₅, P₇₅)	7.2 (4.0, 11.6)	4.5 (3.5, 10.0)	-2.071	0.038
History of EMMs, n (%)
Uveitis	33 (21.7)	13 (26.5)	0.488	0.485
IBD	3 (2.0)	0 (0)	0.982	0.322
PsO	4 (2.6)	1 (2.0)	0.053	0.817
Smoking, n (%)			3.812	0.432
Never	110 (72.4)	37 (75.5)
Occasional	9 (5.9)	2 (4.1)
Frequent	18 (11.8)	3 (6.1)
Secondhand	6 (3.9)	1 (2.0)
Former	9 (5.9)	6 (12.2)
Medication use, n (%)
NSAIDs	109 (71.7)	38 (77.6)	0.643	0.423
csDMARDS	30 (19.7)	7 (14.3)	0.733	0.392
TNF inhibitor	59 (38.8)	18 (36.7)	0.068	0.794
IL-17 inhibitor	30 (19.7)	5 (10.2)	2.342	0.126
BASFI, M (P₂₅, P₇₅)	0.5 (0.1, 1.2)	0.7 (0.2, 1.3)	-1.041	0.298
ASAS-HI, M (P₂₅, P₇₅)	1.0 (0.0, 3.0)	3.0 (0.5, 5.0)	-0.527	0.598
CRP/(mg/L), M (P₂₅, P₇₅)	3.9 (1.8, 6.4)	2.3 (1.7, 5.7)	-1.787	0.074

Items	B	S.E.	Wald	P	OR (95%CI)
Sex (Female)	1.135	0.372	9.314	0.002	3.112 (1.501-6.453)
Age	-0.021	0.025	0.732	0.392	0.979 (0.933-1.027)
Symptom duration	-0.031	0.035	0.795	0.373	0.969 (0.905-1.038)
Constant	-0.519	0.711	0.534	0.465	0.595

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