不同性别系统性硬化症患者的临床特点分析

Sex disparities in clinical characteristics of Chinese patients with systemic sclerosis

目的分析不同性别系统性硬化症(SSc)患者的临床特征,了解不同性别SSc患者的特点。方法对国家风湿病数据中心数据库中2008年8月至2020年6月间注册的SSc患者的临床资料,包括性别、年龄、病程、SSc分型、临床表现、自身抗体、改良Rodnan皮肤评分(mRSS)、医师对病情整体评估(PGA)进行分析。结果入选1844例SSc患者,男289例,女1555例。与女性SSc患者比,男性发病年龄更晚[(48.6±13.7)岁比(45.5±13.1)岁,P<0.001],病程更短[2.0(0.0,4.0)年比3.0(1.0,7.0)年,P<0.001],弥漫皮肤型SSc更常见[63.0%(182/289)比44.2%(688/1555),P<0.001];尽管男性SSc患者吸烟[47.4%(137/289)比1.7%(27/1555),P<0.001]、有害环境接触[7.6%(22/289)比2.1%(33/1555),P<0.001]更多,但肺间质病变发生率男女患者差异无统计学意义[男性为69.3%(181/261),女性为74.5%(1085/1457),P=0.084]。与男性SSc患者比,女性更易出现雷诺现象[87.7%(1364/1555)比75.4%(218/289),P<0.001]、关节炎[11.1%(173/1555)比6.9%(20/289),P=0.032]、反流性食管炎[22.0%(342/1555)比13.1%(38/289),P=0.001]和白细胞减少[10.7(161/1511)%比6.1%(17/279),P=0.019],较少出现指端溃疡[22.5%(350/1555)比30.4%(88/289),P=0.004];女性SSc患者中抗核抗体阳性[85.6%(1310/1531)比78.6%(221/281),P=0.003]、抗核糖核蛋白抗体阳性[23.1%(342/1479)比14.0%(38/271),P=0.001]、抗SSA抗体阳性[28.2%(419/1487)比13.9%(38/274),P<0.001]更常见。男性SSc患者PGA评分[1.4(1.0,2.0)分比1.0(0.3,1.6)分,P<0.001]、mRSS[18.0(9.0,28.0)分比14.0(5.0,28.0)分,P=0.003]更高。结论不同性别的SSc患者临床表现有一定差异,SSc中男性虽然少见,但其发病年龄更晚,更易出现广泛的皮肤受累及指端溃疡,病情可能更重,需引起临床医生的关注。

Objective To evaluate the differences in clinical characteristics between different genders of Chinese patients with systemic sclerosis(SSc).Methods The data of SSc patients registered in Chinese Rheumatism Data Center between August 2008 and June 2020 were retrospectively analyzed.Results A total of 1844 patients with SSc were enrolled in the study.The ratio of males to females was 289 to 1555.The onset age was(48.6±13.7)years in males and(45.5±13.1)years in females(P<0.001).Male patients represented shorter disease duration[2.0(0.0,4.0)years vs.3.0(1.0,7.0)years,P<0.001],higher proportion of diffuse cutaneous SSc(dcSSc)[63.0%(182/289)vs.44.2%(688/1555),P<0.001].Although more man patients experienced smoking[47.4%(137/289)vs.1.7%(27/1555),P<0.001]and exposure to harmful environments[7.6%(22/289)vs.2.1%(33/1555),P<0.001],there was no statistically significant difference in interstitial lung disease between male and female patients[69.3%(181/261)vs.74.5%(1085/1457),P=0.084].Otherwise,Raynaud′s phenomenon[87.7%(1364/1555)vs.75.4%(218/289),P<0.001],arthritis[11.1%(173/1555)vs.6.9%(20/289),P=0.032],gastroesophageal reflux disease[22.0%(342/1555)vs.13.1%(38/289),P=0.001],and leucopoenia[10.7(161/1511)%vs.6.1%(17/279),P=0.019]were more common in female patients,but finger ulcer was less common[22.5%(350/1555)vs.30.4%(88/289),P=0.004].Antinuclear antibody(ANA)positivity rate[85.6%(1310/1531)vs.78.6%(221/281),P=0.003],anti-RNP antibody positivity rate[23.1%(342/1479)vs.14.0%(38/271),P=0.001],anti-SSA antibody positivity rate[28.2%(419/1487)vs.13.9%(38/274),P<0.001]were higher in female patients.Physician′s global assessment(PGA)scores[1.4(1.0,2.0)vs.1.0(0.3,1.6),P<0.001]and modified Rodnan Skin Score(mRSS)[18.0(9.5,28.0)vs.14.0(5.0,28.0),P=0.003]were higher in males.Conclusion Even though male SSc patients account for a small proportion,more extensive skin involvement,finger ulcers and higher PGA are manifested in males.Physicians need pay attention to these clinical disparities between different genders in SSc.