不同性别成人发病放射学阴性中轴型脊柱关节炎的临床特点比较

Differences between Chinese men and women with adult-onset non-radiographic axial spondyloarthritis

目的了解不同性别成人发病放射学阴性中轴型脊柱关节炎(nr-axSpA)的临床特点。方法本研究纳入1999—2020年就诊于汕头大学医学院第一附属医院的成人发病(发病年龄≥16岁)nr-axSpA患者662例,分析其不同性别之间人口学特征及临床特点的差异。结果本组nr-axSpA患者男女性别比例为1.17∶1,HLA-B27阳性率71.8%(475/662),基线病程中位数1.6(0.5,4.0)年,就诊年龄中位数25.0(21.0,33.0)岁。男性与女性相比,发病年龄及初诊年龄更低[21.0(18.0,28.0)岁和25.0(21.0,30.0)岁,Z=5.63,P<0.001;24.0(19.0,32.0)岁和27.0(23.0,34.5)岁,Z=4.91,P<0.001],HLA-B27阳性率更高[78.4%(280/357)和63.9%(195/305),χ^(2)=17.06,P<0.001]。男性患者炎性腰背痛(IBP)、晨僵、夜间痛、附着点炎、髋痛、腹股沟痛的发生率比女性更高,而手小关节受累在女性患者中更常见,差异有统计学意义。初诊时,男性与女性相比,强直性脊柱炎疾病活动度评分(ASDAS)-CRP评分更高[3.0(2.3,3.8)和2.4(2.0,3.0),Z=5.59,P<0.001],病情活动者(ASDAS-CRP>2.1)的比例更高[81.9%(185/226)和67.9%(133/196),χ^(2)=11.08,P=0.001],CRP和ESR升高的比例更高[49.0%(175/357)和27.9%(85/305),χ^(2)=30.85,P<0.001;49.3%(176/357)和33.4%(102/305),χ^(2)=16.98,P<0.001]。结论中国成人发病nr-axSpA患者的性别比例接近,男性患者较女性更早发病,HLA-B27阳性率更高,IBP、附着点炎、髋和腹股沟痛更常见,病情活动度更高,而手小关节受累在女性患者中更常见。

Objective To explore the clinical characteristics of adult-onset non-radiographic axial spondyloarthritis(nr-axSpA)in different genders.Methods A total of 662 patients with adult-onset nr-axSpA(age at disease onset≥16 years)who visited the Rheumatology Department of the First Affiliated Hospital of Shantou University Medical College from 1999 to 2020 were included in the study.Comparisons of baseline demographic and clinical characteristics between different genders were performed.Results Overall,the male-to-female ratio was 1.17∶1,and the prevalence of human leukocyte antigen-B27(HLA-B27)positivity was 71.8%(475/662).The median baseline disease duration and age at diagnosis was 1.6(0.5,4.0)years and 25.0(21.0,33.0)years respectively.The males had a significantly earlier age at disease onset and diagnosis[21.0(18.0,28.0)vs 25.0(21.0,30.0),Z=5.63,P<0.001;24.0(19.0,32.0)vs 27.0(23.0,34.5),Z=4.90,P<0.001,respectively]than females.HLA-B27 positivity was more frequent in males than in females[78.4%(280/357)vs 63.9%(195/305),χ^(2)=17.06,P<0.001].The prevalence of inflammatory back pain(IBP),morning stiffness,nocturnal pain,enthesitis,hip and groin pain were higher in males,whereas females showed a higher prevalence of small joint involvement of the hands.At baseline,males had higher median ankylosing spondylitis disease activity score(ASDAS)-C-reaction protein(CRP)[3.0(2.3,3.8)vs 2.4(2.0,3.0),Z=5.59,P<0.001]and a greater prevalence of high disease activity ASDAS-CRP>2.1[81.9%(185/227)vs 67.9%(133/195),χ^(2)=11.08,P=0.001]than females.The proportions of male patients with elevated CRP levels and erythrocyte sedimentation rate(ESR)were also higher than those of female patients[49.0%(175/357)vs 27.9%(85/305),χ^(2)=30.85,P<0.001;49.3%(176/357)vs 33.4%(102/305),χ^(2)=16.98,P<0.001,respectively].Conclusion The adult-onset nr-axSpA in China is characterized by a comparable sex ratio.Males have an earlier age at disease onset and are higher HLA-B27 positivity with higher prevalence of IBP,enthesitis,hip and groin pain,as well as high disease activity.