强直性脊柱炎队列研究的基线期临床数据分析

发布时间：2018-06-30 18:07

  本文选题：强直性脊柱炎 + 队列研究　； 参考：《中国人民解放军医学院》2016年硕士论文

【摘要】：第一部分 强直性脊柱炎数据库的基线期分析目的：本研究旨在建立基于中国强直性脊柱炎(ankylosing spondylitis, AS)患者的前瞻性队列研究,用以研究中国AS人群的疾病进展、转归及社会经济学特征，从而指导临床实践。方法：在我院风湿科门诊连续收录确诊的AS患者,收集他们的人口学特征(性别、年龄、发病时间、发病特征、家族史等)、患者自我病情评估、附着点炎、关节肿痛、治疗方案等疾病特点,建立基线期资料,之后进行每年至少1次的门诊随访。结果：从2014年5月至2014年12月共收录449例患者的基线期资料(平均年龄29.4±8.5岁,男性84.0%,HLA(人类白细胞抗原)-B27阳性率81.2%)。不同病程AS患者的差异：根据病程时间分为3组(5年内、大于5年且小于等于10年及10年以上)。3组患者在性别分布、HLA-B27阳性率、家族史及是否合并外周关节炎、附着点炎、炎性肠病、银屑病等方面无明显差异。长病程患者更易出现颈部受累(P=0.003)、前胸壁疼痛(P=0.024)以及前葡萄膜炎(P0.001)。结论：我国AS患者的关节外表现患病率明显低于西方人群。长病程患者更易出现胸椎、前胸壁受累和葡萄糖炎。本研究将有助于了解中国AS患者的临床特征、治疗及转归等情况。第二部分基于C反应蛋白计算强直性脊柱炎疾病活动度评分的研究目的：基于C反应蛋白(CRP)计算的强直性脊柱炎疾病活动度评分(ASDAS)是强直性脊柱炎(AS)疾病活动度的首选公式，，旨在寻找CRP取值为何水平时,计算ASDAS-CRP(基于CRP计算的AS疾病活动度评分)为最佳值,为临床准确判断AS病情活动度提供理论依据。方法：2014年5月至2014年12月就诊于解放军总医院的AS患者中,完善化验记录的患者共386例,其中CRP≥3.5 mg/L者266例,CRP3.5 mg/L者120例。通过分析不同CRP水平时ASDAS-CRP与ASDAS-ESR(基于血沉计算的AS疾病活动度评分)的一致性,明确CRP的最佳取值。结果：当CRP ≥ 3.5 mg/L时，ASDAS-CRP与ASDAS-ESR相关性好(r=0.899，P=0.000)。如果CRP3.5mg/L时，CRP水平为1.5mg/L时ASDAS-CRP与ASDAS-ESR间的一致性最好(组内相关系数为0.902;Kappa系数为0.70)，并且以变异轮换法梯度矩阵将ASDAS-CRP与临床病情活动度相结合,同样证实CRP水平为1.5mg/L时最符合临床实际。结论：CRP水平为1.5mg/L时可作为当CRP3.5时计算ASDAS-CRP的CRP最佳取值。
[Abstract]:Part I: baseline Analysis of ankylosing Spondylitis Database objective: to establish a prospective cohort study of patients with ankylosing spondylitis (ankylosing spondylitis, as) in China to study the progression of as in China. The outcome is based on the characteristics of social economics to guide clinical practice. Methods: to collect the demographic characteristics (sex, age, onset time, onset characteristics, family history, etc.), self-assessment, attachment point inflammation, joint swelling and pain of as patients in rheumatological outpatient clinic of our hospital, and to collect their demographic characteristics (sex, age, onset time, onset characteristics, family history, etc.). The treatment program and other disease characteristics, the establishment of baseline data, followed by at least one annual outpatient follow-up. Results: from May 2014 to December 2014, the baseline data of 449 patients were collected (mean age was 29.4 卤8.5 years old, the positive rate of HLA (human leukocyte antigen) -B27 in males was 81.2%). According to the course of disease, the patients were divided into 3 groups (within 5 years, more than 5 years and less than 10 years and more than 10 years). 3 patients had positive rate of HLA-B27 in sex distribution, family history and whether or not they were associated with peripheral arthritis and attachment point inflammation. There was no significant difference in inflammatory bowel disease and psoriasis. Patients with long course of disease were more likely to suffer from neck involvement (P0. 003), anterior chest wall pain (P0. 024) and anterior uveitis (P0. 001). Conclusion: the prevalence of extraarticular manifestations in as patients in China is significantly lower than that in the western population. Patients with long course of disease are more likely to have thoracic vertebrae, anterior chest wall involvement and glucositis. This study will be helpful to understand the clinical features, treatment and outcome of as patients in China. The second part of the study on calculating the disease activity scale of ankylosing spondylitis based on C-reactive protein objective: the disease activity score of ankylosing spondylitis (ASDAS) calculated based on C-reactive protein (CRP) is the first choice formula for disease activity of ankylosing spondylitis (as). In order to find out the level of CRP, ASDAS-CRP (as disease activity score based on CRP) is the best value, which provides a theoretical basis for clinical diagnosis of as disease activity. Methods: from May 2014 to December 2014, 386 patients with as were diagnosed in PLA General Hospital, including 266 patients with CRP 鈮

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