Doran Michele F, Crowson Cynthia S, Pond Gregory R, O'Fallon W Michael, Gabriel Sherine E
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 2002 Sep;46(9):2287-93. doi: 10.1002/art.10524.
A high frequency of infections complicating rheumatoid arthritis (RA) has been described in reports of case series. This retrospective longitudinal cohort study was undertaken to compare the frequency of infections in a population-based incidence cohort of RA patients with that in a group of individuals without RA from the same population.
RA patients included all members of an incidence cohort of Rochester, Minnesota residents ages >or=18 years who were first diagnosed as having RA between 1955 and 1994. One age- and sex-matched subject without RA was selected for each patient with RA. Study subjects were followed up by review of their entire medical record until death, migration from the area, or study end (January 1, 2000), and details of all documented infections, along with information on potential risk factors for infection, were recorded. Hazard ratios for infections were estimated using stratified Andersen-Gill proportional hazards models, with adjustment for potential confounders.
The 609 RA patients and 609 non-RA study subjects (mean age 58.0 years; 73.1% female) were followed up for a mean of 12.7 years and 15.0 years, respectively, reflecting higher mortality among the group with RA. Hazards ratios for objectively confirmed infections, infections requiring hospitalization, and any documented infection in patients with RA were 1.70 (95% confidence interval [95% CI] 1.42-2.03), 1.83 (95% CI 1.52-2.21), and 1.45 (95% CI 1.29-1.64), respectively, after adjustment for age, sex, smoking status, leukopenia, corticosteroid use, and diabetes mellitus. Sites of infection with the highest risk ratios were bone, joints, skin, soft tissues, and the respiratory tract.
In this study, patients with RA were at increased risk of developing infections compared with non-RA subjects. This may be due to immunomodulatory effects of RA, or to agents with immunosuppressive effects used in its treatment.
病例系列报告中描述了类风湿关节炎（RA）并发感染的高发生率。本回顾性纵向队列研究旨在比较以人群为基础的RA患者发病队列与来自同一人群的一组无RA个体的感染发生率。
RA患者包括明尼苏达州罗切斯特市年龄≥18岁、于1955年至1994年间首次被诊断为RA的发病队列的所有成员。为每位RA患者选择一名年龄和性别匹配的无RA受试者。通过查阅研究对象的全部病历对其进行随访，直至死亡、迁出该地区或研究结束（2000年1月1日），记录所有记录在案的感染细节以及感染的潜在危险因素信息。使用分层Andersen-Gill比例风险模型估计感染的风险比，并对潜在混杂因素进行调整。
609例RA患者和609例非RA研究对象（平均年龄58.0岁；73.1%为女性）分别平均随访12.7年和15.0年，这反映出RA组的死亡率较高。在对年龄、性别、吸烟状况、白细胞减少症、使用皮质类固醇和糖尿病进行调整后，RA患者经客观证实的感染、需要住院治疗的感染以及任何记录在案的感染的风险比分别为1.70（95%置信区间[95%CI]1.42 - 2.03）、1.83（95%CI 1.52 - 2.21）和1.45（95%CI 1.29 - 1.64）。风险比最高的感染部位是骨骼、关节、皮肤、软组织和呼吸道。
在本研究中，与非RA受试者相比，RA患者发生感染的风险增加。这可能是由于RA的免疫调节作用，或其治疗中使用的具有免疫抑制作用的药物所致。
