Zhang L, Hu X H, Wang Q W, Cai Y M, Zhao J X, Liu X Y
Department of Rheumatology & Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 18;52(6):1034-1039. doi: 10.19723/j.issn.1671-167X.2020.06.008.
To investigate the population distribution of cervical spine instability in rheumatoid arthritis (RA) patients, and to analyze the clinical characteristics in RA patients with cervical spine instability.
A total of 439 RA patients who had completed cervical spine X-ray examination from Department of Rheumatology and Immunology of Peking University Shenzhen Hospital and Peking University Third Hospital from August 2015 to March 2019 were enrolled. The clinical data, laboratory data and cervical radiographic data were collected and analyzed by -test, rank sum test and Chi-square test to clarify the clinical characteristics in the RA patients with cervical spine instability.
Of the 439 RA patients, 80.9% (355/439) were female, with an average age of (52.9±13.9) years, a median duration of the disease was 60 months, the shortest history was 2 weeks, and the longest history was up to 46 years. 29.6% (130/439) of the RA patients showed cervical spine instability. Among them, 20 RA patients were complicated with two different types of cervical instability, the atlantoaxial subluxation (AAS) accounted for 24.6% (108/439), the vertical subluxation (VS) accounted for 7.3% (32/439) and the subluxial subluxations (SAS) accounted for 2.3% (10/439). The patients with cervical spine instability had a longer duration of disease [120 (36, 240) months . 48 (12, 120) months], a higher proportion of peripheral joint deformity (56.9% . 29.9%), and a higher visual analog scale (VAS) measuring general health score (4.89±2.49 . 3.93±2.38), a lower hemoglobin [(111.31±19.44) g/L . (115.56±16.60) g/L] and a higher positive rate of anti-cyclic citrullina-ted peptide (CCP) antibody (90.8% . 76.6%). There were no significant differences in gender, age, number of swollen joints, number of tenderness joints, erythrocyte sedimentation rate, rheumatoid factor level, 28-joint disease activity score, positive rate of anti keratin antibody, duration of glucocorticoid use and duration of disease modifying anti-rheumatic drugs use between the two groups.
In the study, 29.6% of the RA patients showed cervical spine instability. RA patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity, a higher VAS measuring general health score, a lower hemoglobin and a higher positive rate of anti-CCP antibody.
探讨类风湿关节炎（RA）患者颈椎不稳定的人群分布情况，并分析颈椎不稳定的RA患者的临床特征。
选取2015年8月至2019年3月在北京大学深圳医院风湿免疫科和北京大学第三医院完成颈椎X线检查的439例RA患者。收集其临床资料、实验室数据和颈椎影像学数据，采用t检验、秩和检验和卡方检验进行分析，以明确颈椎不稳定的RA患者的临床特征。
439例RA患者中，80.9%（355/439）为女性，平均年龄为（52.9±13.9）岁，疾病中位病程为60个月，最短病程为2周，最长病程达46年。29.6%（130/439）的RA患者存在颈椎不稳定。其中，20例患者合并两种不同类型的颈椎不稳定，寰枢椎半脱位（AAS）占24.6%（108/439），垂直半脱位（VS）占7.3%（32/439），下位半脱位（SAS）占2.3%（10/439）。颈椎不稳定的患者病程更长[120（36，240）个月 对 48（12，120）个月]，外周关节畸形比例更高（56.9% 对 29.9%），视觉模拟量表（VAS）测量的总体健康评分更高（4.89±2.49 对 3.93±2.38），血红蛋白更低[（111.31±19.44）g/L 对 （115.56±16.60）g/L]，抗环瓜氨酸肽（CCP）抗体阳性率更高（90.8% 对 76.6%）。两组在性别、年龄、肿胀关节数、压痛关节数、红细胞沉降率、类风湿因子水平、28关节疾病活动评分、抗角蛋白抗体阳性率、糖皮质激素使用时间和改善病情抗风湿药物使用时间方面无显著差异。
本研究中，29.6%的RA患者存在颈椎不稳定。颈椎不稳定的RA患者病程长，外周关节畸形比例更高，VAS测量的总体健康评分更高，血红蛋白更低，抗CCP抗体阳性率更高。
