类风湿关节炎合并周围神经病变48例临床分析

The clinical analysis of 48 rheumatoid patients with peripheral neuropathy

目的通过探讨类风湿关节炎(RA)合并周围神经病变的临床特点,了解RA合并周围神经病变的发生率及可能的相关影响因素。方法回顾性研究安徽医科大学第一附属医院2008年1月—2012年12月住院的RA患者共986例,其中合并周围神经病变的患者共48例(研究组),分析与未合并神经病变患者(对照组)的相关临床资料,比较2组的差异。结果①RA患者合并周围神经病变的发病率为4.9%(48/986);研究组与对照组性别差异有统计学意义(χ2=13.091,P=0.001),而平均年龄及病程差异无统计学意义;②研究组DAS评分明显高于对照组(6.03±1.33 vs.4.09±1.21,P<0.01);关节畸形数(4.04±4.90 vs.1.92±3.075,P=0.012)及关节畸形时间[(4.59±7.10)vs.(0.20±1.17)年,P<0.01];CRP[(88.73±40.53)vs.(52.47±30.14)mg/l,P=0.03]、RF[(119.00±59.96)vs.(94.70±62.94)U/ml,P=0.04]、抗CCP抗体[(508.17±548.63)vs.(269.00±320.63)IU/ml,P=0.01]均明显高于对照组,其他临床及实验室指标差异无统计学意义;③研究组使用激素治疗时间[(5.24±1.05)vs.(1.55±0.38)年,P=0.001]、使用剂量[(10.67±8.73)vs.(4.35±4.84)mg,P<0.01]及不正规治疗时间[(9.54±1.32)vs.(4.97±0.75)年,P=0.003]明显较对照组增多,使用慢作用抗风湿药情况差异无统计学意义。结论周围神经病变为RA重要的并发症之一,发生率为4.9%。男性、高DAS28评分、关节畸形个数多及畸形时间长、RF及抗CCP抗体的异常增高、长时间使用激素及不正规治疗等可能是RA合并周围神经病变的相关危险因素。

Abstract：Objective To study the clinical characteristics of rheumatoid patients with peripheral neuropathy. Methods 986 rheumatoid patients of the First Hospital of Anhui University from Jan 2008 to Sep 2012 were analyzed,including 48 rheumatoid patients with peripheral neuropathy and study the occurrence rate and related influencing factors. Results （1） The occurrence rate was 4.9% ;there was no statistically significant difference of age and disease course between two groups, while difference of sex was statistically significant （ X2 = 13.091, P = 0. 001 ） ;（2）The DAS score of rheumatoid pa- tients with peripheral neuropathy was higher than that of control group（6.03± 1.33 vs. 4.09 ± 1.21 ,P 〈0. O001 ） ;there was no statistically significant difference of tender and swelling joints between two groups, while statistically significant difference of the number and time of deformed joints [ （4.04 ± 4.90 vs. 1.92 ± 3. 075,P = O. O12） and （4.59-± 7.10 vs. 0.2 ± 1.17 years,P 〈 0. 001 ） ] ; CRP, RF and anti-CCP of rheumatoid patients with peripheral neuropathy were higher than those of control group. [ （88.73 ± 40.53 vs. 52.47 ± 30.14mg/1,P = 0.03 ）, （ 119 ± 59.96 vs. 94.70 ± 62.94 U/ ml, P = 0.04） and （ 508.17 ± 548.63 vs. 269 ± 320.63 , P = 0.01 ） ] , while no statistically significant difference in other laboratory index ; （3）The time and dose using glucocorticoids and unformal treatment of rheumatoid patients with peripheral neuropathy were higher than those of control group. I （5.24 ± 1.05 vs. 1.55 ± 0.38 years,P = 0. 001 ）, （ 10.67 ± 8.73 vs. 4.35 ± 4.84 mg,P 〈 0. 001 ） and （9.54 ± 1.32 vs. 4.97 ± 0.75 years,P = 0. 003） ] ,with no statistically significant difference of using DMARDs. Conclusion Peripheral neuropathy was one of complications of Rheumatoid arthritis. Male, long unformal treatment,higher DAS score,more number and time of deformed joints, unusual higher RF and anfi-CCP or with ANA and ACL may be associated with peripheral neuropathy in rheumatoid arthritis.