摘要
目的探讨糖尿病和血脂异常对类风湿性关节炎(rheumatoid arthritis,RA)治疗效果的交互影响及预测意义,为RA合并代谢异常患者的个体化治疗提供依据。方法选取2022年6月至2023年6月就诊的180例RA患者作为研究对象。根据患者是否合并糖尿病和血脂异常,将其分为A组(单纯RA组,n=45)、B组(RA合并糖尿病组,n=45)、C组(RA合并血脂异常组,n=45)和D组(RA合并糖尿病和血脂异常组,n=45)。所有患者均按照2018年中国类风湿关节炎诊疗指南给予常规抗风湿治疗,B、D组患者加用二甲双胍控制血糖,C、D组患者加用他汀类药物调脂。治疗3个月后评估疗效,观察指标包括美国风湿病学会(American College of Rheumatology,ACR)20/50/70反应率、疾病活动度评分(disease activity score in 28 joints,DAS28)、C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、糖化血红蛋白(glycated hemoglobin,HbA1c)、空腹血糖(fasting plasma glucose,FPG)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)和高密度脂蛋白胆固醇(highdensity lipoprotein cholesterol,HDL-C)。多因素Logistic回归分析血糖、血脂水平对RA疗效的影响,并通过构建相加模型和相乘模型评估HbA1c和HDL-C的交互作用。结果治疗后,A组ACR20/50反应率显著高于其他三组,ACR70反应率也有较高趋势,D组各项反应率均最低(P<0.05)。D组DAS28、CRP和ESR显著高于其他三组,A组最低(P<0.05)。基线HbA1c水平、基线HDL-C水平、基线DAS28评分是ACR20反应的独立影响因素(P<0.05)。相加模型和相乘模型的比较显示,HbA1c和HDL-C对ACR20反应的影响可能是相互独立的(P=0.652)。结论糖尿病和血脂异常对RA治疗效果具有显著的负面影响,但其交互作用并不显著。对于RA合并代谢异常患者,应在抗风湿治疗的同时积极控制血糖和调节血脂,以提高治疗效果。基线HbA1c和HDL-C水平可作为预测RA治疗反应的重要因素。
Objective To investigate the interactive effects of diabetes and lipid abnormalities on the treatment efficacy of rheumatoid arthritis(RA)and their predictive significance,providing a basis for individualized treatment of RA patients with metabolic disorders.Methods A total of 180 RA patients who visited the hospital between June 2022 and June 2023 were selected as research subjects.Based on whether patients had diabetes and dyslipidemia,they were divided into Group A(RA only,n=45),Group B(RA with diabetes,n=45),Group C(RA with dyslipidemia,n=45),and Group D(RA with both diabetes and dyslipidemia,n=45).All patients received conventional anti-rheumatic treatment according to the 2018 Chinese Rheumatoid Arthritis Diagnosis and Treatment Guidelines.Patients in Group B and D were additionally treated with metformin for blood glucose control,while patients in Group C and D received statins for lipid regulation.Treatment efficacy was assessed after 3 months of treatment.The Observed indicators included American College of Rheumatology(ACR)20/50/70 response rates,Disease Activity Score(DAS28),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),glycated hemoglobin(HbA1c),fasting plasma glucose(FPG),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C).Multivariate logistic regression analysis was used to evaluate the impact of blood glucose and lipid levels on RA treatment efficacy.Additive and multiplicative models were constructed to evaluate the interaction between HbA1c and HDL-C.Results After treatment,Group A showed significantly higher ACR20/50 response rates than the other three groups,and also showed a higher trend in ACR70 response rate.Group D had the lowest response rates across all criteria(P<0.05).Group D also exhibited significantly higher levels of DAS28,CRP,and ESR than the other three groups,while Group A had the lowest levels(P<0.05).Baseline HbA1c level,baseline HDL-C level and baseline DAS28 scores are independent influencing factors for ACR20 response(P<0.05).Comparison of additive and multiplicative models suggested that the effects of HbA1c and HDL-C on ACR20 response might be independent of each other(P=0.652).Conclusion Diabetes and dyslipidemia have significant negative impacts on RA treatment efficacy,but their interaction is not significant.For RA patients with metabolic disorders,it is important to actively control blood glucose and regulate lipid levels while undergoing anti-rheumatic treatment to improve therapeutic outcomes.Baseline HbA1c and HDL-C levels can serve as important predictors for RA treatment response.
作者
杨茂益
刘尚丽
余文景
刘磊
Maoyi YANG;Shangli LIU;Wenjing YU;Lei LIU(Department of Rheumatism and Pain,Sichuan Provincial Orthopedic Hospital,Chengdu Sichuan 610000,China;Department of Neck,Shoulder,Waist and Leg Pain,Sichuan Provincial Orthopedic Hospital,Chengdu Sichuan 610000,China;Infection Control Department,Sichuan Provincial Orthopedic Hospital,Chengdu Sichuan 610000,China)
出处
《昆明医科大学学报》
2025年第7期131-138,共8页
Journal of Kunming Medical University
基金
四川省保健委员会干部保健科研课题(川千研2020-604)。
关键词
类风湿性关节炎
糖尿病
血脂异常
治疗效果
预测因素
Rheumatoid arthritis
Diabetes
Dyslipidemia
Treatment efficacy
Predictive factors
作者简介
杨茂益(1991~),男,四川射洪人,医学硕士,主治医师,主要从事风湿骨关节的研究工作;通信作者:刘尚丽,E-mail:379289632@qq.com。
