银屑病关节炎患者中代谢综合征的患病率及其各组分与临床特征的关联研究

Frequency of metabolic syndrome and correlation with metabolic syndrome in patients with psoriatic arthritis

目的研究PsA患者中代谢综合征(MS)的患病率及MS各组分与PsA临床特征的关联。方法纳入自2017年1月至2019年9月就诊于我科的PsA患者,收集其人口学及临床资料、实验室检查、MS相关指标(身高、体质量、腰围、血压、空腹血糖、血脂谱)及有无高血压、糖尿病、动脉粥样硬化、冠状动脉粥样硬化性心脏病(冠心病)、脑血管病等合并疾病,分析PsA患者中合并MS及其各种亚型表现的患病率和临床特点。结果共纳入162例符合银屑病关节炎分类标准(CASPAR)的PsA患者,其中36例(22.2%)合并高血压,28例(17.2%)合并糖尿病,24例(14.8%)合并动脉粥样硬化,11例(6.7%)合并冠状动脉粥样硬化性心脏病,7例(4.3%)合并脑血管疾病。按照国际糖尿病联盟(IDF)诊断标准,58例(35.8%)PsA患者合并MS。与不合并MS的PsA患者相比,合并MS或高血压、空腹血糖升高的PsA患者年龄更大[分别为(54±10)岁和(44±13)岁,(56±11)岁和(45±12)岁,(54±11)岁和(44±13)岁,t=5.058,P<0.01;t=4.450,P<0.01;t=5.150,P<0.01]、疾病活动度更高[PsA疾病活动度评分(DAPSA)分别为16.75(11.25,26.7)和8.8(4.8,16.4),16.3(9.6,27.8)和10.0(5.1,18.0),14.4(9,25.7)和9.5(5,17.7),t=4.539,P<0.01;t=3.046,P<0.01;t=3.063,P<0.01]。线性回归分析显示MS组分数量与DAPSA评分呈正相关(r=0.273,P<0.01),而多元线性回归现实各代谢综合征各组分中除高血压(标准化系数=0.334,P<0.01)及空腹血糖升高(标准化系数=0.247,P=0.023)外,其余组分与DAPSA评分相关性差异无统计学意义(P>0.05);合并高血压的PsA患者ESR更快[16.5(9.5,34.25)mm/1 h与10(5,24.5)mm/1 h,Z=2.127,P=0.012];合并脂代谢异常的PsA患者CRP更高[5.6(2.1,17.8)mg/L与3.7(1.5,6.5)mg/L,Z=2.543,P<0.01],炎性腰背痛比例更高(41.3%和22.4%,χ2=5.901,P=0.016),DAPSA评分更高[14.1(8.4,24.3)和9.9(5.0,19.4),Z=2.152,P=0.031]。结论PsA患者合并MS并不少见;合并MS的PsA患者年龄更大、疾病活动度更高,临床上需要更多关注。

Objective To investigate the frequency of metabolic syndrome(MS)in patients with psoriatic arthritis(PsA)and further analyze the correlation of MS and its components with clinical features of PsA.Methods Data including demographics,clinical manifestations,laboratory tests,MS-associated features(height,weight,waist circumference,blood pressure,serum lipid spectrum,and so on)and history of complications(hypertension,diabetes mellitus,atherosclerosis,coronary heart disease,and cerebral vascular disease)were collected from PsA patients in our hospital from Jan 2017 to Sep 2019.The frequency of MS in PsA patients was calculated and the association between PsA clinical manifestations and MS as well as its components was investigated.Results One hundred and sixty-two PsA patients who fulfilled the Classification Criteria for Psoriatic Arthritis(CASPAR)were recruited.Hypertension was identified in 36(22.2%)patients,diabetes mellitus in 28(17.2%)patients,coronary heart disease in 11(6.7%)patients,and cerebral vascular disease in 7(4.3%)patients.Based on the criteria of the International Diabetes Federation(IDF),58(35.8%)patients were diagnosed as MS.Compared with MS-free patients,patients with MS,hypertension or diabetes mellitus were older[(54±10 vs 44±13;56±11 vs 45±12;54±11 vs 44±13,respectively,t=5.058,4.450,5.150,P<0.01 for all],with higher disease activity[DAPSA scores 16.75(11.25,26.7)vs 8.8(4.8,16.4),16.3(9.6,27.8)vs 10.0(5.1,18.0),14.4(9,25.7)vs 9.5(5,17.7),Z=4.539,3.046,3.063,P<0.01].There was a positive correlation between the sum of components of MS and DAPSA score(r=0.27,P<0.01),but multiple linear regression showed no correlation between each component with DAPSA score(P>0.05)except for hypertension(P<0.01,standard coefficient=0.334)and elevated fasting blood glucose(P=0.023,standard coefficient=0.247).PsA patients with hypertension had higher ESR[16.5(9.5,34.25)mm/1 h vs 10(5,24.5)mm/1 h,Z=2.127,P=0.012].CRP level was higher in patients with dyslipidemia[5.6(2.1,17.8)mg/L vs 3.7(1.5,6.5)mg/L,Z=2.543,P<0.01].Prevalence of inflammatory back pain was also higher in dyslipidemia patients(41.3%vs 22.4%,χ2=5.901,P=0.016).DAPSA score was higher in dyslipidemia patients(14.1 vs9.9,P=0.031).Conclusion MS and its components are not rare comorbidities in PsA patients.PsA patients with MS tend to be older with higher disease activity,which calls for more attention.