类风湿关节炎合并恶性肿瘤患者的临床特征及相关因素分析

doi:10.3969/j.issn.1004-583X.2021.03.012

摘要/Abstract

摘要：

目的探讨类风湿关节炎(RA)合并恶性肿瘤患者的临床特征及相关因素。方法回顾性分析2013年2月至2019年8月青岛大学附属医院收治的RA合并恶性肿瘤患者的临床资料。共收集具有完整临床资料的RA合并恶性肿瘤患者217例(肿瘤组),并随机选取同期未合并肿瘤的RA患者308例作为对照(对照组)。结果肿瘤组女/男、RA病程、吸烟人数均高于对照组(P<0.05),类固醇激素及传统抗风湿药物使用率则低于对照组(P<0.05)。RA病程、吸烟史、性别差异为RA并发恶性肿瘤的独立危险因素(P<0.05),而甲氨蝶呤或来氟米特治疗史为独立保护因素(P<0.05)。结论 RA患者罹患恶性肿瘤的风险增加;病程长、女性和有吸烟史的RA患者要警惕罹患恶性肿瘤的可能性,而使用甲氨蝶呤或来氟米特治疗RA可降低罹患肿瘤的风险。

关键词: 关节炎, 类风湿, 肿瘤, 抗风湿药

Abstract:

Objective To investigate the clinical characteristics and related factors of rheumatoid arthritis(RA) complicated with malignant tumor inpatients. Methods Clinical data of patients with RA complicated with malignant tumor admitted to the Affiliated Hospital of Qingdao University from February 2013 to August 2019 were retrospectively analyzed. Complete clinical data of a total of 217 patients with RA complicated with malignant tumors were collected(tumor group), and 308 patients with RA but without tumors during the same period were randomly selected as controls(control group). Results The number of women/men, RA duration, and smokers in tumor group were higher than those in control group(P<0.05), while the utilization rate of steroid hormone and traditional anti-rheumatic drugs in tumor group was lower than that in control group(P<0.05). The course of RA, smoking history and gender difference were the independent risk factors of RA complicated with malignant tumor(P<0.05), while the treatment history of methotrexate or leflunomide was the independent protective factor(P<0.05). Conclusion RA patients have an increased risk of malignancy. RA patients with long course of disease, females and smoking history should be alert to the possibility of cancer. Methotrexate or leflunomide can reduce the risk of cancer.

Key words: arthritis, rheumatoid, neoplasms, antirheumatic agents

中图分类号:

R593.22

刘子奕, 王吉波. 类风湿关节炎合并恶性肿瘤患者的临床特征及相关因素分析[J]. 临床荟萃, 2021, 36(3): 246-250.

Liu Ziyi, Wang Jibo. Analysis of clinical characteristics and related factors of rheumatoid arthritis complicated with malignant tumors in patients[J]. Clinical Focus, 2021, 36(3): 246-250.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.03.012

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I3/246

图/表 4

参考文献 19

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肿瘤类型	例数	男/女 (例)	肿瘤先发/ 同年发生/ RA先发(例)	RA发病年龄 (岁)	肿瘤确诊年龄 (岁)	吸烟史 (例)	肿瘤家族史 (例)	类固醇激素 (例)	甲氨蝶呤 (例)	来氟米特 (例)	生物制剂 (例)
肺癌	43	23/20	1/1/41	53.1±11.8	65.3±7.7	23	9	25	18	21	3
甲状腺癌	30	3/27	3/0/27	46.3±12.9	58.7±11.2	2	7	11	15	8	2
乳腺癌	23	0/23	5/0/18	49.7±10.8	60.5±10.2	0	7	7	10	10	1
淋巴瘤	17	6/11	0/3/14	50.5±15.3	59.0±10.8	4	6	11	9	8	1
胃癌	15	9/6	3/0/12	51.2±12.0	60.7±11.2	7	4	6	6	3	0
直肠癌	14	5/9	1/0/13	43.5±16.2	67.2±10.6	5	5	6	4	6	1
结肠癌	12	4/8	2/0/10	55.4±14.5	68.3±9.4	3	0	5	4	4	0
肝癌	9	5/4	1/0/8	42.8±14.5	58.9±10.6	3	2	2	2	2	1
子宫颈癌	8	0/8	0/0/8	44.4±13.0	59.8±6.9	0	5	3	2	3	0
胆囊及胆管癌	7	3/4	0/0/7	56.0±13.4	72.9±7.1	3	0	2	3	2	0
膀胱癌	7	3/4	0/0/7	45.0±14.3	66.3±10.4	2	1	3	4	2	0
喉癌	6	5/1	0/0/6	51.3±8.1	65.5±8.3	5	0	2	3	2	0
前列腺癌	5	5/0	0/0/5	60.2±11.5	76.6±7.7	5	1	3	2	2	1
胰腺癌	5	1/4	0/0/5	46.6±7.1	63.8±5.6	1	2	1	3	1	1
肾癌	4	1/3	0/0/4	47.0±7.6	62.5±7.5	1	0	0	1	0	0
子宫内膜癌	4	0/4	0/0/4	49.3±18.9	59.5±13.1	0	2	2	1	3	0
卵巢癌	3	0/3	0/0/3	45.7±6.1	60.7±3.1	0	0	2	1	2	0
食管癌	3	2/1	0/0/3	48.3±6.5	69.3±6.9	2	1	0	1	1	0
鼻咽癌	2	1/1	0/0/2	47.5±4.5	67.5±11.5	1	0	1	1	1	0
总计	217	76/141	16/4/197	49.6±13.4	63.2±10.5	67	52	92	90	81	11

肿瘤类型	例数	男/女 (例)	肿瘤先发/ 同年发生/ RA先发(例)	RA发病年龄 (岁)	肿瘤确诊年龄 (岁)	吸烟史 (例)	肿瘤家族史 (例)	类固醇激素 (例)	甲氨蝶呤 (例)	来氟米特 (例)	生物制剂 (例)
肺癌	43	23/20	1/1/41	53.1±11.8	65.3±7.7	23	9	25	18	21	3
甲状腺癌	30	3/27	3/0/27	46.3±12.9	58.7±11.2	2	7	11	15	8	2
乳腺癌	23	0/23	5/0/18	49.7±10.8	60.5±10.2	0	7	7	10	10	1
淋巴瘤	17	6/11	0/3/14	50.5±15.3	59.0±10.8	4	6	11	9	8	1
胃癌	15	9/6	3/0/12	51.2±12.0	60.7±11.2	7	4	6	6	3	0
直肠癌	14	5/9	1/0/13	43.5±16.2	67.2±10.6	5	5	6	4	6	1
结肠癌	12	4/8	2/0/10	55.4±14.5	68.3±9.4	3	0	5	4	4	0
肝癌	9	5/4	1/0/8	42.8±14.5	58.9±10.6	3	2	2	2	2	1
子宫颈癌	8	0/8	0/0/8	44.4±13.0	59.8±6.9	0	5	3	2	3	0
胆囊及胆管癌	7	3/4	0/0/7	56.0±13.4	72.9±7.1	3	0	2	3	2	0
膀胱癌	7	3/4	0/0/7	45.0±14.3	66.3±10.4	2	1	3	4	2	0
喉癌	6	5/1	0/0/6	51.3±8.1	65.5±8.3	5	0	2	3	2	0
前列腺癌	5	5/0	0/0/5	60.2±11.5	76.6±7.7	5	1	3	2	2	1
胰腺癌	5	1/4	0/0/5	46.6±7.1	63.8±5.6	1	2	1	3	1	1
肾癌	4	1/3	0/0/4	47.0±7.6	62.5±7.5	1	0	0	1	0	0
子宫内膜癌	4	0/4	0/0/4	49.3±18.9	59.5±13.1	0	2	2	1	3	0
卵巢癌	3	0/3	0/0/3	45.7±6.1	60.7±3.1	0	0	2	1	2	0
食管癌	3	2/1	0/0/3	48.3±6.5	69.3±6.9	2	1	0	1	1	0
鼻咽癌	2	1/1	0/0/2	47.5±4.5	67.5±11.5	1	0	1	1	1	0
总计	217	76/141	16/4/197	49.6±13.4	63.2±10.5	67	52	92	90	81	11

组别		例数		性别(例)		RA确诊年龄 (岁)		RA病程 (年)		CRP (mg/L)		ESR (mm/h)		ACPA阳性 (例)		RF阳性 (例)		使用类固醇激素(例)		使用甲氨蝶呤(例)
组别		例数		男	女	RA确诊年龄 (岁)		RA病程 (年)		CRP (mg/L)		ESR (mm/h)		ACPA阳性 (例)		RF阳性 (例)		使用类固醇激素(例)		使用甲氨蝶呤(例)
RA合并肿瘤组		197		71	126	48.51±13.10		15.20±11.25		11.15±12.46		24.51±18.29		165		158		83		79
RA无肿瘤组		308		62	246	49.36±13.57		7.54±5.54		10.10±10.82		25.76±18.07		259		240		173		213
统计值				χ²=15.678		t=0.693		t=-8.864		t=-0.971		t=0.752		χ²=0.010		χ²=0.374		χ²=9.471		χ²=41.588
P值				<0.05		>0.05		<0.05		>0.05		>0.05		>0.05		>0.05		<0.05		<0.05
组别	例数		使用来氟米特 (例)			使用非甾体抗炎药(例)	使用生物制剂 (例)		吸烟史 (例)		贫血 (例)		肺间质病变 (例)		肿瘤家族史 (例)		关节畸形 (例)		类风湿结节 (例)
RA合并肿瘤组	197		79			36	11		64		10		9		47		31		18
RA无肿瘤组	308		213			77	17		25		7		15		55		38		24
统计值			χ²=11.473			χ²=3.129	χ²=0.001		χ²=49.153		χ²=2.903		χ²=0.024		χ²=2.684		χ²=1.176		χ²=0.285
P值			<0.05			>0.05	>0.05		<0.05		>0.05		>0.05		>0.05		>0.05		>0.05

组别		例数		性别(例)		RA确诊年龄 (岁)		RA病程 (年)		CRP (mg/L)		ESR (mm/h)		ACPA阳性 (例)		RF阳性 (例)		使用类固醇激素(例)		使用甲氨蝶呤(例)
组别		例数		男	女	RA确诊年龄 (岁)		RA病程 (年)		CRP (mg/L)		ESR (mm/h)		ACPA阳性 (例)		RF阳性 (例)		使用类固醇激素(例)		使用甲氨蝶呤(例)
RA合并肿瘤组		197		71	126	48.51±13.10		15.20±11.25		11.15±12.46		24.51±18.29		165		158		83		79
RA无肿瘤组		308		62	246	49.36±13.57		7.54±5.54		10.10±10.82		25.76±18.07		259		240		173		213
统计值				χ²=15.678		t=0.693		t=-8.864		t=-0.971		t=0.752		χ²=0.010		χ²=0.374		χ²=9.471		χ²=41.588
P值				<0.05		>0.05		<0.05		>0.05		>0.05		>0.05		>0.05		<0.05		<0.05
组别	例数		使用来氟米特 (例)			使用非甾体抗炎药(例)	使用生物制剂 (例)		吸烟史 (例)		贫血 (例)		肺间质病变 (例)		肿瘤家族史 (例)		关节畸形 (例)		类风湿结节 (例)
RA合并肿瘤组	197		79			36	11		64		10		9		47		31		18
RA无肿瘤组	308		213			77	17		25		7		15		55		38		24
统计值			χ²=11.473			χ²=3.129	χ²=0.001		χ²=49.153		χ²=2.903		χ²=0.024		χ²=2.684		χ²=1.176		χ²=0.285
P值			<0.05			>0.05	>0.05		<0.05		>0.05		>0.05		>0.05		>0.05		>0.05

组别	例数	CA125(U/ml)	CA153(U/ml)	CA199(U/ml)	CEA(ng/ml)
RA合并肿瘤组	101	12.76(4.15, 43.95)	12.47(3.62, 17.52)	10.05(5.10, 32.41)	2.05(0.66, 10.33)
RA无肿瘤组	70	12.95(5.95, 27.27)	13.42(6.39, 24.26)	12.63(6.79, 24.15)	2.24(0.69, 4.48)
Z值		-1.336	-1.415	-1.006	-1.282
P值		>0.05	>0.05	>0.05	>0.05