CAJ | 학술논문

目的了解类风湿关节炎(RA)患者主要死因构成及预后因素.方法收集我院1990-2011年91例RA死亡患者临床及血清学资料,分析其死因构成及其与病情活动度、用药情况等的关系,采用t检验和x2检验、Mann-WhithreyU检验进行统计分析,并应用比例风险模型(Cox参数回归)探讨预后因素.结果合并感染、心脑血管疾病和肿瘤为RA患者最主要的三大死因,分别占总死亡人数的57％、13％、12％.RA病情中高度活动者死亡比例高,占总死亡人数64％.RA死亡患者系统受累常见,其中以全身症状最常见,包括发热、乏力、体质量下降,占总死亡人数的75％,其次为肺间质纤维化、胸腔积液.多因素分析结果显示多关节外表现是RA死亡的独立危险因素,改善病情抗风湿药(DMARDs)的应用是RA的预后保护因素.结论合并感染、心脑血管疾病和肿瘤是RA最主要死亡原因.多关节外表现是RA预后的独立危险因素.
목적 료해류풍습관절염(RA)환자주요사인구성급예후인소.방법 수집아원1990-2011년91례RA사망환자림상급혈청학자료,분석기사인구성급기여병정활동도、용약정황등적관계,채용t검험화x2검험、Mann-WhithreyU검험진행통계분석,병응용비례풍험모형(Cox삼수회귀)탐토예후인소.결과 합병감염、심뇌혈관질병화종류위RA환자최주요적삼대사인,분별점총사망인수적57％、13％、12％.RA병정중고도활동자사망비례고,점총사망인수64％.RA사망환자계통수루상견,기중이전신증상최상견,포괄발열、핍력、체질량하강,점총사망인수적75％,기차위폐간질섬유화、흉강적액.다인소분석결과현시다관절외표현시RA사망적독립위험인소,개선병정항풍습약(DMARDs)적응용시RA적예후보호인소.결론 합병감염、심뇌혈관질병화종류시RA최주요사망원인.다관절외표현시RA예후적독립위험인소.
Objective To analyze the causes of death and prognostic indicators of rheumatoid arthritis (RA).Methods A retrospective investigation was performed on 91 RA patients who were admitted into our hospital from 1990 to 2011.The clinical features and laboratory data were studied to assess the causes of death and the relationship between causes of death and disease activity and treatment.T test and x2 test were used for statistical analysis.Prognostic indicators of mortality were studied by Cox propor-tional hazards models.The prognostic indicators of RA were also analyzed.Results The three most common causes of death in patients with RA were infection (57％),cardiac-cerebral vascular diseases (13％) and cancer (12％).Severe disease activity and presence of extra-articular manifestations were more common among the patients who died.Seventy-five percent patients presented with systemic symptoms including fever,fatigue and weight loss,followed by pulmonary fibrosis (32％) and pleural effusion (27％).Cox regression analysis revealed that the presence of extra-articular features was independent risk determinant for mortality while DMARDs treatment was the independent protect determinant.Conclusion Infection,cardiac-cerebral vascular diseases and cancer are the main causes of death in RA.The presence of extra-articular features is the independent risk factor of RA.