导致类风湿关节炎患者住院费用增加的主要相关因素分析

Analysis of the main associated factors leading to increased hospitalization costin patients with rheumatoid arthritis

目的研究导致类风湿关节炎患者住院费用增加的主要相关因素。方法按入院先后选取类风湿关节炎患者43例,按出院时总费用分为:A组(<5 000元),B组(5 000～<7 000元)和C组(≥7 000元),比较三组关节症状、实验室指标、治疗方案、胸部高分辨CT、肺功能及合并症分布的差异。结果 A、B、C三组住院费用分别是:(4 328. 4±627. 2)元、(5 712. 9±406. 4)元和(10 113. 0±3 162. 3)元,差异有统计学意义。关节症状、自身抗体、红细胞沉降率、双手X线积分、治疗方案在三组分布差异无统计学意义。住院天数在C组较A和B组明显增加,病程C组较A组明显延长。A、B、C三组间质性肺病(ILD)的阳性率分别为53. 3%,66. 7%,93. 8%,C组较A和B组均明升高。异常胸部高分辨CT在C组较A组明显升高,C组有更多网状、蜂窝、条索、肺气肿、肺大疱,A和B组有更多正常、细小结节、结节、斑片、毛玻璃病变。C反应蛋白、血清铁蛋白、除ILD的呼吸系统疾病(肺部感染、肺动脉高压)在C组分布明显增加。结论呼吸系统疾病,特别是ILD是导致住院费用增加的重要因素,提醒临床医生早期识别和处理这类并发症(合并症),以减轻患者的经济负担。

:Objective Little is known about the contribution of the complications to the cost of hospitalization in rheumatoid arthritis(RA).The objective of this study is to find the main associated factors that contribute to the increased cost of hospitalization for RA patients.Methods 43 RA patients were selected randomly.Those patients were classified into three groups according to the cost of hospitalization:group A(<￥5 000)group B(≥￥5 000,but<￥7 000)group C(≥￥7 000).The distributions of the joint symptoms,laboratory indexes,the manifestations of chest HRCT and the parameters of pulmonary function test(PFT),were compared among three groups.Data were analyzed by SPSS 10.01,P value<0.05 was set for the levels of these test among three groups,and P≤0.05/3 for multiple comparison.Results The costs of hospitalization were￥(4 328.4±627.2),￥(5 712.9±406.4),￥(10 113.0±3 162.3)respectively for group A,B and C and the difference was significant(P=0.000).The distributions of joint symptoms,anto-antibodies,ESR,the X-ray levels of double hands and the therapeutic schedule,were not significantly different.The number of days for hospitalization in group C was significantly higher than that in group A and B.The disease course in group C was significantly higher than that in group A.The positive rates of interstitial lung disease(ILD)were 53.3%,66.7%,93.8%respectively for group A,B and C,and that in group C was significantly higher than that in group A and B.The rate of abnormal chest HRCT was significantly higher in group C than that in group A.The distributions of CRP,SF,and the other respiratory system diseases but not ILD(pulmonary infection,pulmonary arterial hypertension)in group C were significantly higher than those in group A.Conclusions Respiratory system diseases,especially for ILD,are main contributors to the increased cost of hospitalization in rheumatoid arthritis,which reminds doctors to identify those complications and manage them early and reduce the cost of those patients.