河南漯河地区中老年人群类风湿关节炎危险因素调查

Risk factors for rheumatoid arthritis in middle-aged and elderly residents in Luohe City of Henan Province

目的分析河南漯河地区中老年人群类风湿关节炎（RA）患病的危险因素。方法采取两阶段整群抽样的方法对漯河地区≥45岁以上中老年人进行问卷调查以及生化指标检测，依据2010年美国风湿病学会（ACR）联合欧洲抗风湿病联盟（EULAR）提出的RA分类标准进行类风湿关节炎危险因素评估。结果共调查居民8610例，应答率为96．10％。年龄45～94岁，平均（61．4±7．4）岁。男性3361例（40．62％），女性4913例（59．38％）。在年龄分布上，关节受累评分为2、3和5均在60～64岁为最高峰，此年龄段关节受累率分别为2．90％、2．02％和0．26oA。类风湿因子（RF）与抗环瓜氨酸多肽（抗一CCP）抗体滴度均呈现偏态分布。RF和抗CCP抗体低滴度和高低度阳性率女性均较男性高（均P〈0．05）。吸烟是RA独立危险因素（OR：1．79，95％CI：1．34～3．41，Pd0．01），饮酒次数〉1次／d增加RA的发生风险（OR：6．71，95％CI：0．88～51．23，P〈0．01）。农村人群患病率显著高于城郊和市区人群（O．93％比0．53％和0．48％，均为P％0．05）。楼层高是RA的保护因素（OR：0．61，95％CI：0．36～O．94，P=0．036）。遗传因素：家族史是发生RA的独立危险因素（OR；3．09，95％CI：1．53～6．27，P〈0．01），并且一级亲属遗传关系是RA的危险因素（OR=6．45，95％CI：1．67～17．83，P〈0．01）。多因素分析显示女性、居住在一层、吸烟和遗传因素是RA重要危险因素。结论漯河市中老年人群RA危险因素有女性、吸烟、文化程度和遗传因素。

Objectives To investigate the risk factors for rheumatoid arthritis in middle-aged and elderly residents in Luohe City, Henan Province. Methods Survey questionnaires and measurements of biochemical parameters were conducted in individuals 45 years old or above, using the two-stage cluster sampling method. Risk factors for rheumatoid arthritis were evaluated according to the criteria for the classification of RA by the American College of Rheumatology and European League Against Rheumatism（ACR/EULAR） （2010）. Results Among the 8 610 residents covered by the survey,8,274 people responded, representing a response rate of 96.1% .There were 3 361 male （40.62 % ）and 4 913 female（ 59.38 % ）respondents, with an average age of 61.4 ±7.4 （45-91 ）years. The age group of 60-64 years had the highest rates of joint involvement,with those scoring 2,3 and 5 points at 2.90%, 2.02% and 0.26%, respectively. The rheumatoid factor （ RF ） and the anti- cycliccitrullinatedpeptide（anti-CCP）antibody titer showed skewed distributions. The low titer-positive rate of RF and anti-CCP antibody,the ESR and CRP in female residents were evidently higher than in male residents（each P〈0.05）. Smoking was an independent factor for RA（OR： 1.79,95 % CI： 1.34- 3.41, P〈0.01）. The risk for RA occurrence increased with the frequency of drinking 〉1 time/d（OR： 6.71,95%CI：0, 88-51, 23,P〈0.01）. The prevalence of RA was significantly higher in rural areas than in urban and suburb areas（0.93% to 0.48% and 0.53% ,each P〈0.05）. Living on higher floors was a protective factor for RA （OR ： 0.61,95% CI ： 0.36-0.94, P = 0. 036 ）. Family history was an independent risk factor for RA （OR ： 3.09, 95% CI： 1.53-6.27, P〈0.01 ）, and being first degree relatives of RA patients was a risk factor（OR=6.45,95% CI： 1.67-17.83 ,P〈0. 01）. Multiple factor analysis showed that female gender, first floor of residential buildings, smoking and genetics were key risk factors for RA. Conclusions The risk factors for rheumatoid arthritis in middle-aged and elderly residents in Luohe City of Henan Province are female gender,smoking and genetics.