类风湿关节炎合并2型糖尿病的危险因素研究

Risk Factors for Rheumatoid Arthritis Complicated by Type 2 Diabetes Mellitus

目的探讨类风湿关节炎(RA)合并2型糖尿病(T2DM)的发病情况和危险因素。方法回顾性分析2016年1月至2019年12月宿迁市第一人民医院确诊为RA的232例患者的病历资料,根据是否合并T2DM分为2组:观察组(合并T2DM)48例,对照组(未合并T2DM)184例,记录2组的一般资料及T2DM的相关因素。比较本研究组与本地区成年人的糖尿病患病率,比较2组一般资料,应用二分类非条件Logistic回归分析RA患者发生T2DM的危险因素。结果本研究中RA患者T2DM的患病率为20.7%(48/232),显著高于本地区成年人的糖尿病患病率[6.6%(3304/50321)](χ2=74.41,P<0.01);不同年龄段、不同性别RA患者T2DM的患病率均高于一般人群(P<0.05)。与对照组比较,观察组在年龄[(61.0±7.97)岁vs(53.97±12.34)岁,Z=-3.78,P<0.01]、RA病程[(12.21±11.26)]年vs(8.68±9.90)年,Z=-2.03,P<0.05]和BMI[(24.22±3.92)vs(22.96±3.65)kg·m-2,Z=-1.97,P<0.05]等方面差异有统计学意义。从实验室检查结果看,观察组低密度脂蛋白胆固醇(LDL-C)水平显著高于对照组[(3.29±0.76)mmol·L-1 vs(2.81±0.78)mmol·L-1,Z=-3.94,P<0.01];观察组疾病活动评分红细胞沉降率(DAS28-ESR)[(5.95±1.50)vs(5.49±1.89),Z=-3.10,P<0.01]、C反应蛋白(DAS28-CRP)[(5.13±1.28)vs(4.66±1.60),Z=-2.82,P<0.01)]、简化的疾病活动指数(SDAI)[(36.64±15.75)vs(29.65±15.62),Z=-10.64,P<0.01)]及临床疾病活动性指数(CDAI)[(31.13±13.52)vs(25.19±13.28),Z=-4.77,P<0.01)]均显著高于对照组(均P<0.01)。在治疗上,观察组糖皮质激素使用率显著高于对照组(68.8%vs 44.6%,χ2=9.73,P<0.01)、硫酸羟氯喹(HCQ)的使用率显著低于对照组(41.7%vs 60.3%,χ2=5.39,P<0.05)。二分类非条件Logistic回归分析显示,DAS28-CRP[OR=2.234(95%CI 1.122~4.448)]和糖皮质激素使用[OR=2.265(95%CI 1.110~4.624)]是RA患者发生T2DM的独立危险因素。结论类风湿关节炎患者2型糖尿病的发生率较高,受到多种因素的影响。DAS28-CRP评分高和糖皮质激素的使用可能是其独立危险因素。RA合并T2DM是免疫调节紊乱基础上多种因子的共同结果。

Objective To investigate the incidence and risk factors of rheumatoid arthritis(RA)complicated by type 2 diabetes mellitus(T2DM).Methods A retrospective analysis was carried out on 232 patients diagnosed with RA in Suqian First Hospital from January 2016 to December 2019.These RA patients were divided into two groups:observation group(48 patients with T2DM)and control group(184 patients without T2DM).The general data and relevant factors for T2DM were recorded in both groups.The prevalence of T2DM was compared between patients in this study and adults in this region.The risk factors for T2DM in RA patients were analyzed with two-classification non-conditional logistic regression.Results The prevalence of T2DM among RA patients in this study(20.7%,48/232)was higher than that among adults in this region(6.6%,3304/50321)(χ2=74.41,P<0.01).Furthermore,the prevalence of T2DM in RA patients of different ages and genders was higher than that in general population(P<0.05).There were significant differences between control group and observation group in age[(61.0±7.97)years vs(53.97±12.34)years,Z=-3.78,P<0.01],RA duration[(12.21±11.26)years vs(8.68±9.90)years,Z=-2.03,P<0.05],and body-mass index[(24.22±3.92)kg·m-2 vs(22.96±3.65)kg·m-2,Z=-1.97,P<0.05].The low-density lipoprotein cholesterol concentration DAS28-ESR(28-joint disease activity score using erythrocyte sedimentation rate),DAS28、|CRP(DAS28 using C reactive protein),simplified disease activity index(SDAI)and clinical disease activity index(CDAI)in observation group were higher than those in control group[(3.29±0.76)mmol·L-1 vs(2.81±0.78)mmol·L-1,(5.95±1.50)vs(5.49±1.89),(5.13±1.28)vs(4.66±1.60),(36.64±15.75)vs(29.65±15.62)and(31.13±13.52)vs(25.19±13.28),respectively;Z=-3.94,-3.10,-2.82,-10.64 and-4.77,respectively;P<0.01].Moreover,compared with the control group,the observation group had an increased rate of glucocorticoid utilization(68.8%vs 44.6%,χ2=9.73,P<0.01)and a decreased rate of hydroxychloroquine sulfate utilization(41.7%vs 60.3%,χ2=5.39,P<0.05).Two-classification non-conditional logistic regression analysis showed that DAS28-CRP(OR=2.234,95%CI:1.122-4.448)and glucocorticoid use(OR=2.265,95%CI:1.110-4.624)were independent risk factors for T2DM in RA patients.Conclusion The incidence of T2DM is high among patients with RA and is affected by various factors.High DAS28-CRP and glucocorticoid use may be the independent risk factors for T2DM in RA patients.RA combined with T2DM is a common result of multiple factors based on a disorder of immune regulation.