Bély M, Apáthy A
Országos Reumatológiai és Fizioterápiás Intézet, Budapest.
Orv Hetil. 1994 Sep 11;135(37):2029-34.
The frequency of basic diseases, complications, causes of death and associated illnesses were studied on non selected autopsy material of 161 patients with rheumatoid arthritis died at the National Institute of Rheumatology in 1970-1992. The authors determined the incidence of severe complications such as systemic vasculitis, generalized secondary amyloidosis, generalized septic infection and miliary epithelioid granulomatosis (probably miliary tuberculosis). In 122 cases (75.8%) the RA, while in the remaining 39 (24.2%) cases other basic disease was the underlying cause of death. Vasculitis was observed in 36 cases (22.4%), amyloidosis in 34 (21.1%), sepsis in 22 (13.7%), and miliary tuberculosis in 6 (3.7%) out of 161 RA patients. Vasculitis led to death in 19 (11.8%), amyloidosis in 17 (10.6%), sepsis in 22 (13.7%) cases. However, none of the miliary tuberculosis was direct cause of death. In 76 cases (47.2%) rheumatoid arthritis was not complicated by vasculitis, amyloidosis, sepsis or military tuberculosis and in 85 cases (52.8%) one or more of these complications existed in the necropsy material of 161 RA patients. In 74 patients (46%) only one complication and in 11 (6.8%) more than one from the mentioned complication existed simultaneously in the same patients. Vasculitis was detected clinically in 7 patients (relative frequency: 19.4%), amyloidosis in 8 (relative frequency: 23.5%), sepsis in 10 (relative frequency: 45.4%), however none of the 6 mT was detected clinically. Out of 98 complications in 85 Rheumatoid patients only 25 were recognized clinically (25.5%).
对1970年至1992年在国立风湿病研究所死亡的161例类风湿关节炎患者的非选择性尸检材料,研究了基础疾病、并发症、死亡原因及相关疾病的发生频率。作者确定了严重并发症的发生率,如系统性血管炎、全身性继发性淀粉样变性、全身性败血症感染和粟粒性上皮样肉芽肿(可能为粟粒性肺结核)。122例(75.8%)患者的死因是类风湿关节炎,其余39例(24.2%)患者的死因是其他基础疾病。161例类风湿关节炎患者中,36例(22.4%)出现血管炎,34例(21.1%)出现淀粉样变性,22例(13.7%)出现败血症,6例(3.7%)出现粟粒性肺结核。血管炎导致19例(11.8%)患者死亡,淀粉样变性导致17例(10.6%)患者死亡,败血症导致22例(13.7%)患者死亡。然而,粟粒性肺结核均不是直接死因。76例(47.2%)类风湿关节炎患者未并发血管炎、淀粉样变性、败血症或粟粒性肺结核,85例(52.8%)患者的尸检材料中存在一种或多种上述并发症。74例(46%)患者仅有一种并发症,11例(6.8%)患者同时存在一种以上上述并发症。临床上检测到7例血管炎患者(相对频率:19.4%),8例淀粉样变性患者(相对频率:23.5%),10例败血症患者(相对频率:45.4%),然而6例粟粒性肺结核患者均未在临床上被检测到。85例类风湿患者的98种并发症中,只有25种在临床上被识别(25.5%)。