类风湿性关节炎患者颈椎病变加重的相关危险因素

Risk factors for aggravation of cervical lesions in patients with rheumatoid arthritis

目的探讨类风湿性关节炎(rheumatoid arthritis,RA)患者颈椎病变加重的相关危险因素。方法选择2010年1月~2016年12月在该院诊断为RA并存在颈椎病变的117例患者作为研究对象,所有患者于2018年1月~2020年12月在该院再次行放射学检查。根据是否颈椎病变加重,将患者分为病变加重组和非病变加重组,比较两组患者年龄、病程、寰枢关节半脱位(atlantoaxial subluxation,AAS)、脊柱半脱位(vertebra subluxation,VS)、下颈椎半脱位(lower cervical subluxation,LCS)、X线检查间隔、基于C反应蛋白的疾病活动评分28(C-reactive protein based disease activity score 28,DAS28-CRP)及治疗史等资料,采用多因素分析探讨影响颈椎病变进展的风险因素。结果颈椎病变加重组患者的生物制剂应用率显著低于非加重患者,差异有统计学意义(P<0.05)。两组患者年龄、病程、性别、X线检查间隔、基线DAS28-CRP评分、破坏性变化、糖皮质激素应用、MTX应用等资料差异均无统计学意义(P>0.05);加重组患者AAS发生率低于非加重组,VS和LCS发生率高于非加重组,差异均有统计学意义(P<0.05)。多因素logistic分析显示,LCS是RA患者颈椎病变加重的风险因素,生物制剂是RA患者颈椎病变加重的保护性因素(P<0.05)。结论基线LCS与RA患者的颈椎病变加重相关,生物制剂可延缓RA患者颈椎病变的加重。

Objective To explore the related risk factors of aggravation of cervical lesions in patients with rheumatoid arthritis(RA).Methods A total of 117 patients diagnosed with rheumatoid arthritis(RA)with cervical spondylopathy in our hospital from January,2010 to December,2016 were selected as the study objects,and all patients underwent radiologic examination again in our hospital from January,2018 to December,2020.According to whether the cervical lesions were aggravated,the patients were divided into aggravated lesions and non lesion plus recombination.The age,course of disease,atlantoaxial subluxation(AAS),vertebra subluxation(VS),lower cervical subluxation(LCS),course of disease,X-ray interval,C-reactive protein based disease activity score 28(das28-crp)and treatment history were compared between the two groups.Multivariate analysis was used to analyze the risk factors affecting the progression of cervical lesions.Results The application rate of biological agents in patients with cervical spondylopathy plus recombinant was significantly lower than that in non aggravated patients(P<0.05).There was no significant difference in age,course of disease,gender,X-ray interval,baseline das28-crp,destructive changes,glucocorticoid and MTX between patients with aggravation of cervical lesions and patients without recombination(P>0.05).The incidence of AAS in the exacerbation group was lower than that in the non recombination group,and the incidence of VS and LCS was higher than that in the non recombination group(P<0.05).Multivariate logistic analysis showed that LCS was the risk factor of cervical spondylopathy in RA patients,and biological agents were the protective factor of cervical spondylopathy in RA patients(P<0.05).Conclusion Baseline LCS is associated with the progression of cervical lesions in RA.Biological agents can delay the progression of cervical lesions in RA.