类风湿性关节性患者肩关节病变的相关危险因素探讨

摘要

Objective To investigate the occurrence and related risk factors of shoulder joint disease in patients with rheumatoid arthritis (RA).Methods From June 2016 to May 2017, 38 cases RA patients with shoulder joint lesions were selected as the experimental group, and 38 cases of RA patients without shoulder joint lesions were enrolled as the control group.The two groups’ routine survey data, ultrasound result and laboratory test indicators were compared to explore the risk factors for shoulder disease in RA patients.Results In the experimental group, the result showed that the lesions on the shoulder joint occurred in 51 shoulders, including 10 cases of bone erosion, 7 tendinitis, 11 joint effusion, 13 synovial hyperplasia, and 10 shoulder cuff lesions.Compared with the control group, the levels of ACCP, CRP and ESR in the experimental group were significantly increased (P＜0.05). Single factor logistic regression analysis showed that shoulder joint lesions in RA patients were related to moderate and severe physical labor, excessive shoulder movement, inflammation, history of trauma, rheumatoid factor, ACCP, CRP, ESR and other factors.Logistic regression analysis showed that related risk factors for shoulder joint disease in RA patients include moderate and severe physical labor, shoulder excessive movement, inflammation, trauma history and elevated levels of RF-IgA, RF-IgM, ACCP and CRP, ESR, etc.Conclusion Understanding the risk factors for shoulder joint disease in patients with RA is important for early prevention and treatment of shoulder lesions.%目的 探讨类风湿性关节炎(rheumatoid athritis,RA)患者肩关节病变的发生情况与相关危险因素.方法 选择2016年6月至2017年5月收治的38例RA患者合并肩关节病变的临床资料作为试验组,同期收治38例无肩关节病变的RA患者资料作为对照组,对两组常规调查资料、B超检查结果与实验室检测指标进行比较.结果 试验组经超声检查显示51侧肩关节发生病变,包括骨质侵蚀10侧、肌腱炎7侧、关节积液11侧、滑膜增生13侧、肩袖病变10侧.与对照组相比,试验组的抗环瓜氨酸肽抗体(anti cyclic citrullinated peptide ,ACCP)、 C-反应蛋白(C-reactive protein, CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)水平均显著提高(P＜0.05).单因素条件Logistic回归分析,RA患者肩关节病变的发生与中重度体力劳动、肩部过度运动、炎症、外伤史、类风湿因子、ACCP、CRP、ESR等因素相关.进一步多因素分析显示,RA患者肩关节病变的相关危险因素包括中重度体力劳动、肩部过度运动、炎症、外伤史以及RF-IgA、RF-IgM、ACCP、CRP、ESR水平升高等.结论 了解RA患者肩关节病变的相关危险因素,对早期防治肩关节病变,避免病变加重具有重要意义.