类风湿关节炎患者临床深度缓解的影响因素分析

Influencing factors of clinical deep remission in patients with rheumatoid arthritis

目的探讨影响类风湿关节炎(RA)患者实现临床深度缓解的相关因素。方法回顾性分析2015年1月至2020年12月北京大学人民医院收治的767例RA患者的临床资料,其中103例达到临床深度缓解的患者为观察组,按照随机数字表法选取205例未达到临床深度缓解患者为对照组。分析观察组患者的临床特征,并通过logistic回归分析临床深度缓解的预测因素。结果观察组中年龄<60岁和无晨僵的患者比例明显高于对照组(P均<0.01);对照组28个肿胀关节(SJC28)≥2、28个压痛关节≥2、合并其他慢性病、血红蛋白降低、红细胞沉降率(ESR)与C-反应蛋白升高和高IgA血症患者比例显著高于观察组(P=0.02)。多因素Logistic分析结果显示,年龄<60岁、无晨僵是RA患者达到临床深度缓解的独立预测因素,而SJC28≥2、ESR升高为不利因素(P均<0.05)。结论年轻、无晨僵以及疾病活动度较低,有利于临床深度缓解。

Objective To investigate the influencing factors of clinical deep remission in patients with rheumatoid arthritis(RA).Methods A retrospective analysis was conducted based on a cohort of seven hundred and sixty seven RA patients in the Peking University People’s Hospital from January 2015 to December 2020.In the cohort,103 patients achieved clinical deep remission,and 205 patients who did not reach clinical deep remission were randomly selected as the control group.The clinical characteristics of patients in the observation group were analyzed,and the predictors of clinical deep remission were analyzed by logistic regression.Results In the clinical deep remission group,the rates of patients aged<60 years and without morning stiffness were higher than those in the non-clinical deep remission group(all P<0.01).Compared with the patients in the clinical deep remission group,the rates of other chronic diseases,28 swollen joint count(SJC28)≥2,28 tender joint count(TJC28)≥2,decreased Hb,elevated ESR and CRP were significantly higher in the non-clinical deep remission group(all P<0.01).Significantly higher IgA was found in the non-clinical deep remission group(P=0.02).Multivariate logistic regression analysis showed that age<60 years and without morning stiffness were independently positive predictors,while SJC28≥2,and elevated ESR were negatively predictors of clinical deep remission remission(all P<0.05).Conclusions Young,without morning stiffness and relatively low disease activity are favorable to clinical deep remission.