类风湿关节炎合并糖代谢异常患者的临床特征分析

Clinical Feature Analysis of Patients with Rheumatoid Arthritis with Abnormal Glucose Metabolism

目的 探讨类风湿关节炎(RA)合并糖代谢异常的临床特点及危险因素。方法 对2017年1月-2022年1月于云南省中医医院风湿病科住院的1 157例RA患者进行回顾性分析,分为RA组、RA合并空腹血糖受损(IFG)组与RA合并2型糖尿病(T2DM)组,比较3组患者的临床资料,包括人口学特征、空腹血糖(GLU)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(sUA)、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体检测结果。采用Logistic回归分析RA患者发生IFG和T2DM的危险因素。结果 RA合并IFG组年龄、病程、RF-IgM、ESR、CRP、TC、LDL-C、GLU均高于RA组,差异均有统计学意义(P<0.05)。RA组年龄、病程、RF-IgG、CRP、UA、TC、TG、LDL-C、GLU水平以及高脂血症患者的比例明显低于RA合并T2DM组,差异均有统计学意义(P<0.05)。Logistic多因素分析发现,ESR、CRP、LDL-C、GLU水平升高均是RA患者发生IFG的独立危险因素,长RA病程,高水平LDL-C和GLU均是RA患者发生T2DM的独立危险因素。结论 RA合并IFG和T2DM患者存在多种代谢指标异常,ESR、CRP、LDL-C水平升高导致RA患者发生IFG的可能性增加;长RA病程,高水平LDL-C均可导致RA患者发生T2DM的可能性增加。

Objective To investigate the clinical features and risk factors of rheumatoid arthritis(RA) with abnormal glucose metabolism. Methods A retrospective analysis was conducted on 1 157 patients with RA who were hospitalized in the department of rheumatology of Yunnan Provincial Hospital of Traditional Chinese Medicine from January 2017 to January 2022. They are divided into RA group, RA combined fasting blood glucose impaired(IFG) group and RA combined type 2 diabetes mellitus(T2DM) group. The clinical data of the three groups were compared, including demographic characteristics, fasting blood glucose(GLU), total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), and low-density lipoprotein cholesterol(LDL-C), serum uric acid(sUA), erythrocyte sedimentation rate(ESR), Creactive protein(CRP), rheumatoid factor(RF), anticyclic citrullinide peptide(CCP) antibody test results. Logistic regression was used to analyze risk factors for IFG and T2DM in patients with RA. Results The age, course, RF-IgM, ESR, CRP, TC,LDL-C and GLU of the combined IFG group were all higher than those in the RA-only group, and the differences were statistically significant(P <0.05). The proportion of patients with age, disease course, RF-IgG, CRP, UA, TC, TG, LDL-C,GLU levels, and hyperlipidemia in the RA group alone was significantly lower than that in the combined T2DM group, and the differences were statistically significant(P <0.05). Logistic multivariate analysis found that ESR, CRP, LDL-C, and elevated GLU levels were independent risk factors for IFG in RA patients and independent risk factors for IFG in RA patients. Long course of RA, high levels of LDL-C, and GLU were independent risk factors for T2DM in patients with RA.Conclusion There were multiple metabolic index abnormalities in patients with RA and IFG and T2DM, and the increase in the levels of ESR, CRP and LDL-C leads to an increase in the possibility of IFG in RA patients. Long courses of RA and high levels of LDL-C can lead to an increased likelihood of T2DM in patients with RA.