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类风湿关节炎伴周围神经病变患者的临床特征及潜在相关危险因素。

Clinical characteristics of rheumatoid arthritis patients with peripheral neuropathy and potential related risk factors.

机构信息

Department of Rheumatology, Linyi People's Hospital, No. 27 East Jiefang Road, Linyi, 276000, Shandong, China.

Department of Neurology, Linyi People's Hospital, Linyi, 276000, Shandong, China.

出版信息

Clin Rheumatol. 2019 Aug;38(8):2099-2107. doi: 10.1007/s10067-019-04521-5. Epub 2019 Mar 25.

Abstract

OBJECTIVES

To investigate potential risk factors of peripheral neuropathy (PN) in rheumatoid arthritis patients (RA).

METHODS

Eighty-eight patients with RA were enrolled in this study, including patients with PN (n = 44; 28 patients with multiple nerves (MN) involvement and 16 patients with single nerve (SN) involvement) and without (n = 44) peripheral neuropathy were enrolled. Their clinical features were comprehensively collected including symptoms/signs, lab results, electromyogram data. T test or chi-squared test and further binary regression analysis were used to explore risk factors based on analyzing these clinical features.

RESULTS

There was no difference as regards patients' age (59.50 ± 8.11 vs 58.68 ± 11.44 years), gender ratio (female/male, 29:15 vs 29:15), and disease duration (6.34 ± 7.87 vs 8.13 ± 9.52 months) between patients with and without PN. RA patients with PN had lower total protein (61.13 ± 7.06 vs 66.06 ± 6.44 g/L), anti-CCP levels (239.13 ± 203.77 vs 361.41 ± 168.09 U/ml) compared with control patients, while patients with MN had higher inflammatory parameters (white blood cells, platelet, C-reactive protein (CRP), erythrocyte sedimentation rate, rheumatoid factor) than patients with SN (p < 0.05). Low total protein (< 63 g/L, 30/44 vs. 12/44) and anti-CCP (< 285.7 U/ml, 27/44 vs. 11/44) were risk factors for patients with PN, while CRP (> 6 mg/L, 26/28 vs. 6/16) and PLT (> 243 × 10/L, 25/28 vs.5/16) were related to the development of MN.

CONCLUSIONS

RA patients with PN, especially MN can present various clinical symptoms, which will aggravate patients' anxiety and depression status. The increase of blood platelet, and CRP levels and decrease of blood albumin are probable risk factors for PN in RA patients.

摘要

目的

探讨类风湿关节炎(RA)患者周围神经病变(PN)的潜在危险因素。

方法

本研究纳入 88 例 RA 患者,包括伴 PN(n=44;28 例多发性神经病(MN)和 16 例单发性神经病(SN))和不伴 PN(n=44)患者。全面收集其临床特征,包括症状/体征、实验室检查结果和肌电图数据。采用 t 检验或卡方检验及进一步的二元回归分析,根据这些临床特征进行分析,探讨危险因素。

结果

伴 PN 和不伴 PN 的 RA 患者在年龄[(59.50±8.11)岁比(58.68±11.44)岁]、性别比(女/男,29∶15 比 29∶15)和病程[(6.34±7.87)月比(8.13±9.52)月]方面差异无统计学意义。伴 PN 的 RA 患者总蛋白[(61.13±7.06)g/L 比(66.06±6.44)g/L]和抗环瓜氨酸肽(CCP)水平[(239.13±203.77)U/ml 比(361.41±168.09)U/ml]低于对照组,而 MN 患者的炎症参数[白细胞、血小板、C 反应蛋白(CRP)、红细胞沉降率、类风湿因子]高于 SN 患者(p<0.05)。低总蛋白(<63 g/L,30/44 比 12/44)和低抗 CCP(<285.7 U/ml,27/44 比 11/44)是 PN 患者的危险因素,而 CRP(>6 mg/L,26/28 比 6/16)和血小板(>243×10/L,25/28 比 5/16)与 MN 的发生有关。

结论

RA 伴 PN,尤其是 MN 的患者可出现多种临床症状,这将加重患者的焦虑和抑郁状态。血小板、CRP 水平升高和白蛋白降低可能是 RA 患者 PN 的危险因素。

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