类风湿关节炎22例死亡原因分析及文献复习

The causes of death in rheumatoid arthritis:a report of 22 cases and literature review

目的分析类风湿关节炎(RA)的死亡原因,提高对RA死因认识,加强治疗对策,提高防治水平。方法对22例RA患者死亡原因进行回顾性分析,并复习25年相关文献。结果22例RA患者的平均死亡年龄为(62±9)岁,平均病程(16±10)年。合并恶性肿瘤6例(宫颈癌、喉癌、结肠癌和多发性骨髓瘤各1例,胃癌2例),占27%;合并严重感染6例(肠道感染伴休克2例,肺部感染、胆囊炎伴胰腺炎、胆道感染和皮肤感染伴败血症各1例),为27%;肺间质病变伴感染致呼吸衰竭3例,占14%;脑血管病变3例,占14%;肾功能不全、心血管病变各1例,占9%;2例患者死在家中,原因不明,占9%。结论RA患者平均寿命缩短近10年,死亡的主要原因为合并感染和恶性肿瘤,其次为肺间质病变和脑血管病变。

Objective To promote the understanding of the causes of death in patients with rheuma-toid arthritis(RA)and to improve the prevention and therapy strategy of RA.Method Retrospectively analy-sis the death of twenty-two patients with RA and review the literatures in recent25years.Results Twenty two patients with RA,the average age of death was(62±9)years old,the mean duration was(16±10)years.Six27%cases died from malignancy(1carcinoma of cervix and larynx,cancer of colon,multiple myeloma,re-spectively;2gastric carcinoma),6(27%)from severe infection(2cases intestinal infection with shock,1pul-monary infection,1cholecystitis complicated with pancreatitis,1cholangitis and1skin infection with septice-ma,respectively),3(14%)died from respiratory failure attributed to interstitial lung disease and3(14%)from the cerebral vascular accident,respectively;1attributed to renal failure and1to cardiovascular accident,ac-count for about9%;the reason of death could not be identified in2cases(9%)becauses they died at home.Conclusion The life span of patients with RA has been reduced by10years.The causes of death are mainly infection and malignancy.Interstitial lung disease and cerebral vascular accident are also contribute.