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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (2): 307-312. doi: 10.19723/j.issn.1671-167X.2026.02.013

• 论著 • 上一篇    下一篇

类风湿关节炎合并慢性病贫血患者的临床特征及相关因素

魏慧, 张警丰, 姚中强, 赵金霞*()   

  1. 北京大学第三医院风湿免疫科, 北京 100191
  • 收稿日期:2023-08-29 出版日期:2026-04-18 发布日期:2025-10-28
  • 通讯作者: 赵金霞
  • 基金资助:
    北京大学第三医院临床队列建设项目(BYSYDL2022017)

Clinical characteristics and relevant factors of rheumatoid arthritis patients with anemia of chronic disease

Hui WEI, Jingfeng ZHANG, Zhongqiang YAO, Jinxia ZHAO*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-08-29 Online:2026-04-18 Published:2025-10-28
  • Contact: Jinxia ZHAO
  • Supported by:
    the Peking University Third Hospital Clinical Trial Construction Project(BYSYDL2022017)

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摘要：

目的: 分析类风湿关节炎(rheumatoid arthritis, RA)合并慢性病贫血(anemia of chronic disease, ACD)的相关因素, 以指导临床合理诊疗。方法: 选取2013年1月至2018年12月于北京大学第三医院风湿免疫科住院的RA患者的病例资料进行回顾性分析, 收集患者临床资料(包括一般情况、关节病变情况、关节外表现及合并症)、实验室检查及治疗情况, 分析RA合并ACD(RA-A组)与不合并ACD(RA-nA组)患者的临床特点差异, 并采用单因素和多因素Logistic回归分析RA合并ACD的相关因素。结果: 共纳入468例RA患者, 其中RA-A组194例(41.5%), RA-nA组274例(58.5%), 两组患者在年龄、性别、发病年龄、病程方面差异均无统计学意义(P均>0.05)。RA-A组较RA-nA组患者的关节肿胀数更多[13(2, 14) vs. 10(2, 11)], 压痛数更多[10(2, 12) vs. 7(2, 10)], 28个关节疾病活动度评分(28 joint disease activity scores, DAS28)更高[DAS28-CRP(C反应蛋白, C-reactive protein): 5.2±1.4 vs. 4.6±1.5;DAS28-ESR(红细胞沉降率, erythrocyte sedimentation rate): 5.9±1.5 vs. 5.1±1.8], 差异均有统计学意义(P均 < 0.05)。RA-A组胸腔积液(4.6% vs. 1.1%)、静脉血栓形成(5.7% vs. 1.5%)的发生率更高(P均 < 0.05)。RA-A组患者血小板计数、中性粒细胞/淋巴细胞、血小板/淋巴细胞、ESR、CPR、免疫球蛋白G(immunoglobulin G, IgG)均显著高于RA-nA组(P均 < 0.05)。Logistic回归分析显示, ESR>20 mm/h、CRP>3 mg/dL、DAS28评分>5.1是RA患者发生ACD的独立危险因素。结论: RA合并ACD的患者关节受累更严重, 炎症指标更高, 疾病活动度更高, 且更容易出现胸腔积液和静脉血栓; 高疾病活动度、高炎症状态、静脉血栓是RA合并ACD的危险因素。

关键词: 类风湿关节炎, 贫血, 慢性病, 危险因素

Abstract:

Objective: To analyze the related factors of rheumatoid arthritis (RA) patients with anemia of chronic disease (ACD) and to guide the clinical diagnosis and treatment. Methods: A retrospective study was used to analyze the patients admitted to Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018. Clinical data (including general conditions, joint lesions, extra-articular manifestations, and comorbidities), laboratory examinations, and treatment were collected to analyze the differences in clinical characteristics between group RA with ACD (RA-A) and group RA without ACD (RA-nA). Univariate and multivariate Logistic regression analysis was conducted to screen for relevant factors of RA with ACD. Results: A total of 468 RA patients were included, including 194 cases (41.5%) in RA-A group and 274 cases (58.5%) in RA-nA group. There were no significant differences in age, gender, onset age, or course of disease between the two groups (P>0.05). The RA-A group had more joint swelling [13 (2, 14) vs. 10 (2, 11)], more tenderness [10 (2, 12) vs. 7 (2, 10)], and higher 28 joint disease activity scores (DAS28) [DAS28-CRP (C-reactive protein): 5.2±1.4 vs. 4.6±1.5; DAS28-ESR (erythrocyte sedimentation rate): 5.9±1.5 vs. 5.1±1.8] compared with the RA-nA group (P < 0.05). The incidence of pleural effusion (4.6% vs. 1.1%) and venous thrombosis (5.7% vs. 1.5%) were higher in RA-A group (P < 0.05). The platelet count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, ESR, CRP, immunoglobulin G (IgG) in RA-A group were significantly higher than those in RA-nA group (P < 0.05). Elevated ESR and CRP levels, DAS28 > 5.1 were relevant factors for anemia in the RA patients. Conclusion: RA patients with ACD had more severe joint involvement, higher inflammatory indicators, and more active conditions, making them more prone to pleural effusion and venous thrombosis. High disease activity, high inflammatory status, and venous thrombosis were risk factors for RA with ACD.

Key words: Rheumatoid arthritis, Anemia, Chronic disease, Risk factors

中图分类号: 

  • R593.22

表1

RA-A组和RA-nA组患者的一般情况比较"

Items RA-A (n=194) RA-nA (n=274) χ2/t P
Age/years, ${\bar x}$±s 58±14 59±15 -0.371 0.714
Male, n(%) 58 (29.9) 64 (23.4) 2.520 0.112
Onset age/years, ${\bar x}$±s 49±15 51±16 -1.093 0.278
Course of disease/years, M (P25, P75) 9 (1, 12) 8 (1, 10) 1.209 0.245

表2

RA-A组患者的红细胞参数及造血原料数值(n=194)"

Items RA-A, ${\bar x}$±s Reference (range)
HCT 0.37±0.12 0.35-0.45
MCV/fL 80±11 82-100
MCH/pg 28±5 27-34
MCHC/(g/L) 344±17 316-354
SF/(μmol/L) 45.4±23.6 7.8-32.2
Ferritin/(μg/L) 168±72 13-150
TIBC/% 36.7±2.8 37.5-60.7
UIBC/% 38.2±7.9 35-48
Falate/(nmol/L) 36.1±23.5 7.0-46.4
Vitamin B12/(μmol/L) 403±146 157-602

表3

RA-A组和RA-nA组患者的关节病变比较"

Items RA-A (n=194) RA-nA (n=274) t/Z P
Swelling, M (P25, P75) 13 (2, 14) 10 (2, 11) -3.501 < 0.001
Tenderness, M (P25, P75) 10 (2, 12) 7 (2, 10) -3.129 < 0.001
DAS28-CRP, ${\bar x}$±s 5.2±1.4 4.6±1.5 -4.634 < 0.001
DAS28-ESR, ${\bar x}$±s 5.9±1.5 5.1±1.8 -5.940 < 0.001
VAS, ${\bar x}$±s 4.7±2.1 4.5±2.6 6.793 0.787

表4

RA-A组和RA-nA组患者的关节外表现和合并症情况比较"

Items RA-A (n=194) RA-nA (n=274) χ2 P
Extra-articular manifestations
  Vasculitis 2 (1.0) 1 (0.4) 0.791 0.374
  Rheumatoid nodules 11 (5.7) 13 (4.7) 0.200 0.655
  Peripheral neuropathy 5 (2.6) 4 (1.5) 0.752 0.386
  Pericarditis 4 (2.1) 5 (1.8) 0.034 0.854
  Pleural effusion 9 (4.6) 3 (1.1) 5.711 0.017
  ILD 43 (22.2) 46 (16.8) 2.132 0.144
Complications
  Venous thrombosis 11 (5.7) 4 (1.5) 6.490 0.011
  SS 27 (13.9) 25 (9.1) 2.642 0.104
  CVD and CBD 26 (13.4) 30 (10.9) 0.649 0.421
  Diabetes 32 (16.5) 53 (19.3) 0.620 0.431
  Tumor 8 (4.1) 5 (1.8) 2.223 0.136
  Peptic ulcer 14 (7.2) 17 (6.2) 0.188 0.664

表5

RA-A组和RA-nA组患者的实验室检查结果比较"

Items RA-A (n=194) RA-nA (n=274) t/χ2 P
White cell/(×109/L), ${\bar x}$±s 6.7±2.3 7.1±2.9 1.060 0.050
Hemoglobin/(g/L), ${\bar x}$±s 99.4±13.5 121.6±15.2 23.628 < 0.001
Platelet/(×109/L), ${\bar x}$±s 299.2±111.6 264.1±96.2 -4.758 < 0.001
Neutrophils/(×109/L), ${\bar x}$±s 4.6±2.1 4.7±2.5 0.373 0.435
Lymphocyte/(×109/L)，${\bar x}$±s 1.5±0.6 1.7±0.6 3.658 < 0.001
NLR, ${\bar x}$±s 3.6±2.8 3.1±1.8 -2.437 0.018
PLR, ${\bar x}$±s 232.5±132.1 173.9±88.6 -6.444 < 0.001
Albumin/(g/L), ${\bar x}$±s 27.6±8.9 28.3±9.2 0.492 0.398
RF positive, n(%) 145 (74.7) 201 (73.4) 0.113 0.737
Anti-CCP positive, n(%) 139 (71.6) 216 (78.8) 3.199 0.074
ESR/(mm/h), ${\bar x}$±s 62.1±29.0 37.6±27.9 -11.358 < 0.001
CRP/(mg/dL), ${\bar x}$±s 5.4±4.6 2.9±1.9 -7.498 < 0.001
IgG/(×109/L), ${\bar x}$±s 15.7±5.2 13.9±4.4 -5.860 < 0.001
IgM/(×109/L), ${\bar x}$±s 3.3±1.6 3.3±2.2 -0.595 0.863
IgA/(×109/L), ${\bar x}$±s 1.4±1.3 1.4±0.9 -0.669 0.391

表6

单因素Logistic回归分析RA患者发生ACD的危险因素"

Risk factors B SE Wald P OR 95%CI
Pleural effusion 1.388 0.673 4.249 0.039 4.005 1.071-14.981
Venous thrombosis 1.307 0.591 4.884 0.027 3.694 1.159-11.770
ESR>20 mm/h 1.474 0.255 33.355 < 0.001 4.366 2.647-7.199
CRP>3 mg/dL 1.177 0.194 36.750 < 0.001 3.245 2.218-4.747
Joint tenderness>5 0.544 0.200 7.428 0.006 1.724 1.165-2.550
Joint swelling>5 0.480 0.185 6.736 0.009 1.617 1.125-2.324
DAS28>5.1 1.411 0.288 24.041 < 0.001 4.100 2.333-7.206
Course of disease>10 years -0.147 0.185 0.631 0.427 0.863 0.600-1.241

表7

多因素Logistic回归分析RA患者发生ACD的危险因素"

Risk factors B SE Wald P OR 95%CI
Pleural effusion 1.323 0.748 3.131 0.077 3.755 0.867-16.260
Venous thrombosis 1.166 0.639 43.329 0.048 3.210 1.317-11.233
ESR>20 mm/h 1.131 0.306 13.620 < 0.001 3.099 1.700-5.649
CRP>3 mg/dL 0.712 0.216 10.830 0.001 2.037 1.334-3.113
Joint tenderness 0.096 0.252 0.145 0.703 1.101 0.672-1.802
Joint swelling 0.162 0.223 0.525 0.469 1.175 0.759-1.819
DAS28＞5.1 1.007 0.445 5.121 0.024 2.738 1.144-6.552
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