不同性别类风湿关节炎患者临床特点对比分析

Clinical characteristics of patients with rheumatoid arthritis in different gender

目的探讨不同性别类风湿关节炎(RA)患者的临床特点。方法选择61例男性RA患者和83例女性RA患者为研究对象,记录2组患者的一般资料、心血管疾病危险因素、有无间质性肺病、有无冠状动脉粥样硬化性心脏病及RA相关药物使用情况,并检测血清血脂、空腹血糖、超敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy)水平,比较2组患者各指标的差异。通过Spearman秩相关分析确定不同性别RA患者各生物化学指标与hs-CRP的相关性。结果男性RA患者吸烟率显著高于女性(P<0.01);冠状动脉粥样硬化性心脏病发病率显著高于女性(P<0.05)。男性RA患者血清总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均显著低于女性(P<0.01);hs-CRP水平显著高于女性(P<0.05);Hcy水平显著高于女性(P<0.01)。男、女性RA患者HDL-C与hs-CRP水平均呈负相关(r=-0.253,P=0.049;r=-0.414,P=0.000)。结论 RA是一种高度异质性疾病,男性较女性疾病活动度高,心血管受累问题突出,病情相对较重。对男性RA患者更应积极干预相关因素,减少心血管不良事件的发生。

Objective To explore the clinical features of different gender patients with rheumatoid arthritis（ RA）.Methods Sixty-one male patients and 83 female patients with RA were chosen as objects. General parameters,risk factors of cardiovascular disease,interstitial lung disease,coronary artery disease and medications associated with RA were recorded; serum lipid level,fasting blood glucose,high-sensitivity C-reactive protein（ hs-CRP） and homocysteine（ Hcy） were measured;differences of each index between the two groups were compared. Spearman ranked correlation analysis was performed to detect the correlationship between serum biochemical indicators and hs-CRP of RA patients in different gender. Results The prevalence rate of smoking and coronary artery disease were higher in male patients than those of female patients,respectively（ P 0. 01,P 0. 05）. Serum total cholesterol,high density lipoprotein cholesterol（ HDL-C） and low density lipoprotein cholesterol（ LDL-C） levels of male patients with RA were significantly lower than those of female patients with RA（ P 0. 01）; serum hsCRP level was higher than that of female RA patients（ P 0. 05）,and Hcy level was significantly higher than that of female RA patients（ P 0. 01）. Serum HDL-C level of male and female patients with RA were both negatively correlated with the level of hs-CRP（ r =- 0. 253,P = 0. 049; r =- 0. 414,P = 0. 000）. Conclusions RA is characterized by a high heterogeneity.Male patients with RA have higher disease activity,more cardiovascular involvement and relatively severer condition. Therefore,positive interventions on relevant factors are of great importance to the prevention of cardiovascular adverse events in patients with RA,particularly male.