摘要
目的探讨老年(≥60岁)起病的类风湿关节炎(elderly onset rheumatoid arthritis,EORA)患者的临床特征及外周血免疫细胞亚群特点。方法以2023年3—12月在新疆维吾尔自治区人民医院风湿免疫科住院的类风湿关节炎(rheumatoid arthritis,RA)患者为研究对象,收集患者的人口学资料、临床特点、关节外表现、实验室检测结果,并根据起病年龄,将患者分为EORA组和青壮年(<60岁)起病的RA(young adult onset rheumatoid arthritis,YORA)组,比较两组临床特征及外周血免疫学指标。结果共入选符合纳入和排除标准的RA患者187例,其中EORA组89例,YORA组98例,平均年龄(62.1±12.0)岁。与YORA组相比,EORA组男性(39.3%比22.4%,P=0.012)、合并间质性肺疾病(21.4%比3.1%,P<0.001)、贫血(10.1%比3.1%,P=0.049)患者比例更高,以大关节起病更为常见(53.9%比23.5%,P<0.001),关节肿胀数[6(2,11)个比3(1,7)个,P=0.002]、压痛数[8(4,13)个比5(3,9)个,P=0.001]更多,炎症反应更重[C-反应蛋白:12.3(3.9,33.2)mg/L比5.5(1.8,16.9)mg/L,P=0.000;红细胞沉降率:30.5(15.0,63.0)mm/h比19.0(8.0,41.0)mm/h,P=0.006],基于C-反应蛋白和红细胞沉降率的28关节疾病活动度评分亦更高[4.0(2.7,5.0)分比3.2(2.4,4.9)分,P=0.002;4.3(2.8,5.3)分比3.4(2.1,4.7)分,P=0.001]。外周血免疫指标方面,EORA组CD4+T细胞比例[(44.1±10.6)%比(48.8±10.7)%,P=0.045]低于YORA组,而自然杀伤细胞比例[(14.8±8.9)%比(10.1±3.7)%,P=0.003]和绝对值计数[(230.2±156.7)个/μL比(155.9±106.5)个/μL,P=0.014]显著高于YORA组。结论与YORA相比,EORA男性比例、关节病变程度、疾病活动度均更高,易合并间质性肺疾病、贫血及高炎症状态,且外周血NK细胞水平更高。
Objective To investigate the clinical features and peripheral blood immune cell subsets ofelderly(≥60 years old)onset rheumatoid arthritis(EORA)patients.Methods The patients with rheumatoid arthritis(RA)who were hospitalized in the Department of Rheumatology and Immunology of the People's Hospital of Xinjiang Uygur Autonomous Region from March 2023 to December 2023 were selected as the study objects.The demographic data,clinical characteristics,extra-articular manifestations and laboratory examination results of the patients were collected.The patients were divided into EORA group and young adult(<60 years old)onset rheumatoid arthritis(YORA)group,and the clinical features and peripheral blood immunological indexes of the two groups were compared.Results A total of 187 RA patients with an average age of(62.1±12.0)years were enrolled,including 89 patients in the EORA group and 98 patients in the YORA group.Compared with YORA group,EORA group had a higher proportion of male patients(39.3%vs.22.4%,P=0.012),patients with interstitial lung disease(21.4%vs.3.1%,P<0.001),and patients with anemia(10.1%vs.3.1%,P=0.049).The onset of large joint was more common in the EORA group(53.9%vs.23.5%,P<0.001).The number of joint swelling[6(2,11)vs.3(1,7),P=0.002],and the number of tenderness[8(4,13)vs.5(3,9),P=0.001]were also higher in the EORA group.Greater inflammation[C-reactive protein(CRP):12.3(3.9,33.2)mg/L vs.5.5(1.8,16.9)mg/L,P=0.000;erythrocyte sedimentation rate(ESR):30.5(15.0,63.0)mm/h vs.19.0(8.0,41.0)mm/h,P=0.006],higher DAS28-CRP score[4.0(2.7,5.0)vs.3.2(2.4,4.9),P=0.002]and DAS28-ESR score[4.3(2.8,5.3)vs.3.4(2.1,4.7),P=0.001]were also observed.In terms of peripheral blood immune indexes,the proportion of CD4+T cells in EORA group[(44.5±10.6)%vs.(48.8±10.7)%,P=0.045]was lower than that in YORA group,while the proportion of NK cells[(14.8±8.9)%vs.(10.1±3.7)%,P=0.003]and absolute count[(230.2±156.7)PCS/μL vs.(155.9±106.5)PCS/μL,P=0.014]in EORA group were higher than those in YORA group.Conclusions Compared with YORA,EORA has higher male proportion,joint disease degree and disease activity.EORA is prone to interstitial lung disease,anemia and high inflammation,and the level of peripheral blood NK cells is higher.
作者
李正芳
吴婵媛
马梦思
李婷婷
吴雪
孟新艳
张莎
武丽君
LI Zhengfang;WU Chanyuan;MA Mengsi;LI Tingting;WU Xue;MENG Xinyan;ZHANG Sha;WU Lijun(Department of Rheumatology and Immunology,People's Hospital of Xinjiang Uygur Autonomous Region,Uygur 830001,China;Xinjiang Clinical Research Center for Rheumatoid arthritis,Uygur 830001,China;Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《协和医学杂志》
北大核心
2025年第1期59-64,共6页
Medical Journal of Peking Union Medical College Hospital
基金
新疆维吾尔自治区重点研发项目(2022B03002-1)。
关键词
老年
非老年
类风湿关节炎
免疫细胞
elderly
non-elderly
rheumatoid arthritis
immune cell
作者简介
通讯作者:武丽君,E-mail:wwlj330@126.com。
