类风湿关节炎患者腰椎滑脱的患病率及其相关因素

Prevalence and related factors of lumbar spondylolisthesis in patients with rheumatoid arthritis

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者腰椎滑脱(lumbar spondylolisthesis,LS)的患病率及其相关因素。方法选择2019年1月~2020年12月在本院就诊的RA患者作为研究对象,评估LS发生率,根据患者是否发生LS分为LS组和非LS组,收集并比较两组患者临床资料(包括性别、年龄、RA病程、Steinbrocker分类分期、血清C反应蛋白(C-reactive protein,CRP)、28个关节压痛数、28个关节肿胀关节数、疾病活动度的VAS评分、28个关节疾病活动度与CRP被利用(DAS28/CRP)、关节手术史、是否存在颈椎不稳、甲氨蝶呤(methotrexate,MTX)使用情况、糖皮质激素使用情况、糖皮质激素剂量、生物制剂应用情况等。对上述资料数据进行单因素分析和多因素Logistic回归分析,以筛选RA患者并发LS的风险因素。结果163例RA患者中,57例74个节段患有LS,发生率为34.97%。单因素分析显示,LS患者和非LS患者性别、年龄、Steinbrocker分期、RA病程、CRP、关节手术史、颈椎不稳、糖皮质激素应用比例等差异存在统计学意义(P<0.05)。多因素Logistic回归分析显示,CRP和关节手术史是影响RA患者LS发生的风险因素(P<0.05)。结论RA患者发生LS的患病率较高,与LS相关的风险因素是血清CRP水平和关节手术史。

Objective To investigate the prevalence and related factors of lumbar spondylolisthesis(LS)in patients with rheumatoid arthritis(RA).Methods RA patients in our hospital from January 2019 to December 2020 were selected as the research objects.The incidence of LS was evaluated.According to whether patients had LS,they were divided into LS group and non-LS group.The clinical data[including gender,age,RA course,Steinbroker classification,Steinbroker grade,serum C-reactive protein(CRP)],28 joint tenderness,28 joint swelling,VAS score of disease activity,28 joint disease activity and CRP utilization(DAS28/CRP),joint operation history,cervical instability,methotrexate(MTX)use,glucocorticoid use,glucocorticoid dose,biological agents application,etc.of the two groups were compared.Single factor analysis and multivariate logistic regression analysis were performed on the above data to analyze the risk factors of RA patients with LS.Results Among 163 RA patients,57 patients(34.97%)had LS in 74 segments.Univariate analysis showed that there were significant differences between LS patients and non-LS patients in gender,age,Steinbroker stage,RA course,CRP,history of joint surgery,cervical instability,proportion of glucocorticoid use(P<0.05).Multivariate logistic analysis showed that CRP and history of joint surgery were risk factors for LS in RA patients(P<0.05).Conclusion The prevalence of LS in RA patients is high,and the related factors of LS are serum CRP level and joint surgery history.