Li Hailong, Li Qingyang, Duan Xinwang, Zhang Shangzhu, Wang Yanhong, Xu Jian, Li Qin, Wu Lijun, Wu Zhenbiao, Yang Min, Liu Shengyun, Su Jinmei, Li Mengtao, Zeng Xiaofeng, Gao Xiang
Department of Nutrition, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Rheumatol Ther. 2024 Apr;11(2):397-409. doi: 10.1007/s40744-024-00646-5. Epub 2024 Feb 13.
Anemia and malnutrition are recognized indicators of suboptimal physical condition in chronic inflammatory diseases. This study aimed to examine the association between anemia, low body mass index (BMI), and clinical outcomes in axial spondyloarthritis (axSpA).
This cross-sectional analysis utilized data from the multicenter ChinaSpA cohort. A total of 4146 participants with axSpA were categorized into four groups based on BMI and hemoglobin levels: those with both anemia and low BMI, those with anemia only, those with low BMI only, and those with neither condition. Logistic regression analyses were performed to analyze the association between anemia, low BMI, inflammation status, functional impairment, and disease activity.
Anemia was present in 13.94%, low BMI in 11.99%, and both conditions in 2.15% of axSpA participants. Those with both anemia and low BMI showed significantly higher levels of inflammation (hypersensitive C-reactive protein [hsCRP] 30.60 mg/L vs. 8.44 mg/L), functional impairment (Bath Ankylosing Spondylitis Functional Index [BASFI] 3.80 vs. 2.10), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] 4.52 ± 2.04 vs. 3.67 ± 2.21; Ankylosing Spondylitis Disease Activity Score calculated with C-reactive protein [ASDAS_CRP] 3.51 ± 1.10 vs. 2.62 ± 1.21) compared to those without these conditions. After adjusting for sex and age, significant associations were observed between elevated hsCRP levels and the presence of low BMI (odds ratio [OR] 1.44, 95% CI 1.17-1.78), anemia (OR 1.91, 95% CI 1.56-2.32), and their concurrent presence (OR 3.59, 95% CI 2.22-5.80). Similarly, increased BASFI was significantly associated with low BMI (OR 1.57, 95% CI 1.25-1.97), anemia (OR 1.47, 95% CI 1.19-1.80), and their combination (OR 3.11, 95% CI 2.02-4.78).
All-cause anemia and low BMI are prevalent complications in patients with axSpA, exhibiting a significant correlation with elevated inflammation status and functional impairment. The simultaneous occurrence of anemia and low BMI particularly exacerbates clinical outcomes, emphasizing the critical role of comprehensive nutritional assessment and management in the therapeutic strategy for axSpA.
贫血和营养不良是慢性炎症性疾病中身体状况欠佳的公认指标。本研究旨在探讨贫血、低体重指数（BMI）与轴性脊柱关节炎（axSpA）临床结局之间的关联。
本横断面分析利用了多中心中国脊柱关节炎队列研究的数据。根据BMI和血红蛋白水平，将4146例axSpA参与者分为四组：同时患有贫血和低BMI者、仅患有贫血者、仅患有低BMI者以及两者均无者。进行逻辑回归分析以分析贫血、低BMI、炎症状态、功能障碍和疾病活动之间的关联。
axSpA参与者中，贫血发生率为13.94%，低BMI发生率为11.99%，两者兼有的发生率为2.15%。与无这些情况的参与者相比，同时患有贫血和低BMI的参与者炎症水平（超敏C反应蛋白[hsCRP] 30.60mg/L对8.44mg/L）、功能障碍（巴斯强直性脊柱炎功能指数[BASFI] 3.80对2.10）和疾病活动度（巴斯强直性脊柱炎疾病活动指数[BASDAI] 4.52±2.04对3.67±2.21；基于C反应蛋白计算的强直性脊柱炎疾病活动评分[ASDAS_CRP] 3.51±1.10对2.62±1.21）显著更高。在调整性别和年龄后，观察到hsCRP水平升高与低BMI（比值比[OR] 1.44，95%置信区间1.17 - 1.78）、贫血（OR 1.91，95%置信区间1.56 - 2.32）及其同时存在（OR 3.59，95%置信区间2.22 - 5.80）之间存在显著关联。同样，BASFI升高与低BMI（OR 1.57，95%置信区间1.25 - 1.97）、贫血（OR 1.47，95%置信区间1.19 - 1.80）及其合并情况（OR 3.11，95%置信区间2.02 - 4.78）显著相关。
全因性贫血和低BMI是axSpA患者中普遍存在的并发症，与炎症状态升高和功能障碍显著相关。贫血和低BMI同时出现尤其会加重临床结局，强调了全面营养评估和管理在axSpA治疗策略中的关键作用。
