类风湿关节炎患者Sharp评分影响因素的临床研究

Influencing factors of Sharp score in patients with rheumatoid arthritis

目的分析类风湿关节炎(RA)患者双手X线Sharp评分的影响因素。方法选取648例RA患者,对所有患者进行双手X线摄片并进行X线分期和Sharp评分,记录患者的一般资料及临床各项指标,比较不同组间患者Sharp评分的差别及影响因素。结果女性RA患者Sharp评分高于男性,差异有统计学意义(P<0.01);不同年龄和不同病程组患者Sharp评分比较差异均有统计学意义(均P<0.05),且随着病程的延长,Sharp评分有逐渐增高趋势。不同DAS28组患者Sharp评分差异有统计学意义(P<0.01),随着DAS28增加,Sharp评分呈逐渐增高趋势;RF阳性组和抗CCP阳性组Sharp评分均高于阴性组(均P<0.01)。多元线性回归分析显示年龄与Sharp评分呈负相关(P<0.01),病程和DAS28与Sharp评分均呈正相关(均P<0.05)。RA患者X线分期-Sharp评分ROC曲线显示:当Sharp评分为20.5分时,AUC面积最大,为0.958(P<0.01),其灵敏度为0.86,特异度为0.93。多元logistic回归分析显示性别、病程和DAS28是RA患者Sharp评分的危险因素(均P<0.05)。结论女性、长病程和高DAS28均是RA患者双手Sharp评分的危险因素,但药物治疗对Sharp评分影响很小。

Objective To explore the influencing factors for Sharp score in patients with rheumatoid arthritis （RA）. Methods The clinical and laboratory data of 648 patients with RA were retrospectively reviewed. The X-ray findings of both hands were staged and scored according to Sharp＇s criteria. The influencing factors of Sharp score were analyzed. Results The median of Sharp score in female RA patients was higher than that in male patients（P〈0.01）. There were significant differences in Sharp score among patients with different age or disease duration（both P〈0.05）, and the Sharp score increased gradually along with increase of disease duration. Sharp score among different DAS28 groups were statistically different （P〈0.01）, and tended to increase with the augment of DAS28. Sharp score were higher in group with positive RF or anti-CCP than that in group with negative RF or anti-CCP（all P〈0.01）. Multivariate linear regression analysis showed that age was negatively correlated with Sharp score （P〈0.01）, duration and DAS28 were positively correlated with Sharp score（both P〈0.05）. ROC curve showed that the area under curve（AUC） was the largest at 0.958 when the Sharp score were 20.5 and the sensitivity was 0.86, the specificity was 0.93. Multivariate logistic regression analysis revealed that sex, disease duration and DAS28 were independent influencing factors for Sharp score in RA（all P〈0.05）. Conclusion Longer disease duration, female and higher DAS28 are influencing factors for Sharp score in RA patients. However, medication intervention has little effect on the Sharp score.