诊断年龄对风湿性多肌痛临床特征的影响: 68例患者的单中心回顾性队列研究

doi:10.3969/j.issn.1004-583X.2022.07.005

摘要/Abstract

摘要：

目的比较不同诊断年龄(>60岁和≤60岁)风湿性多肌痛(polymyalgia rheumatica, PMR)患者的临床特征。方法回顾性分析2013年1月至2019年12月我院诊治的风湿性多肌痛患者68例,依据诊断年龄,分为PMR≤60岁组(24例)和PMR>60岁组(44例),比较两组临床资料(一般资料、临床表现、实验室指标、治疗反应)。结果两组病程、是否吸烟差异均无统计学意义( $P$ >0.05),与PMR≤60岁组相比,PMR>60岁组女性占比更高( $P$ <0.05);两组在体重减轻、发热、肩胛带肌痛、骨盆带肌痛、颈痛、腰痛、晨僵方面比较,差异均无统计学意义( $P$ >0.05);两组乳酸脱氢酶(LDH)水平差异无统计学意义( $P$ >0.05),与PMR≤60岁组相比,PMR>60岁组血沉(ESR)、 C反应蛋白(CRP)水平较高,血红蛋白(Hb)水平较低(均 $P$ <0.05);所有的患者均接受一线糖皮质激素治疗,两组单独使用糖皮质激素占比、糖皮质激素累积剂量差异均无统计学意义( $P$ >0.05),与PMR>60岁组相比,PMR≤60岁组复发占比较少( $P$ <0.05)。结论与诊断年龄>60岁的PMR患者相比,诊断年龄≤60岁的患者复发风险较低,更积极的糖皮质激素治疗是不合理的。

关键词: 风湿性多肌痛, 年龄, 糖皮质激素类

Abstract:

Objective To compare the clinical manifestations of polymyalgia rheumatica (PMR) patients with different ages at diagnosis (>60 years and ≤60 years). Methods Sixty eight patients with PMR who were diagnosed and treated in our hospital from January 2013 to December 2019 were retrospective analyzed. The patients were divided into the PMR≤60 years old group (24 cases) and PMR>60 years old group (44 cases) based on different diagnosis age. The clinical data (general data, clinical features, laboratory indicators, treatment response) of two groups were compared. Results The differences in the course of disease and smoking between two groups weren’t statistically significant (P>0.05), and the proportion of women in the PMR>60 years old group was higher compared with that in the PMR≤60 years old group (P<0.05). The differences in the weight reduction, fever, shoulder girdle myalgia, pelvic girdle myalgia, neck pain, low back pain and morning stiffness weren’t statistically significant between groups (P>0.05); the difference in the level of lactate dehydrogenase (LDH) between groups wasn’t statistically significant (P>0.05). The level of the PMR>60 years old group had higher level of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and lower hemoglobin (Hb) level when compared with such indicators in the PMR≤60 years old group (P<0.05 at all points). All patients received the first-line glucocorticoid therapy, the differences in the proportion of glucocorticoids administered exclusively and cumulative doses of patients between two groups weren’t statistically significant (P>0.05). The proportion of recurrence in the PMR≤60 years old group was less when compared with that in the PMR≤60 years old group, (P<0.05). Conclusion Patients with the age at diagnosis ≤60 years old have a lower risk of recurrence compared with PMR patients with the age at diagnosis >60 years, and more aggressive glucocorticoid therapy is unreasonable.

Key words: polymyalgia rheumatica, age, glucocorticoids

中图分类号:

R593.21

林长艺, 宋明辉, 吴培埕. 诊断年龄对风湿性多肌痛临床特征的影响: 68例患者的单中心回顾性队列研究[J]. 临床荟萃, 2022, 37(7): 612-615.

Lin Changyi, Song Minghui, Wu Peicheng. Effects of diagnosis age on clinical manifestations of polymyalgia rheumatica: A single center retrospective cohort study on 68 patients[J]. Clinical Focus, 2022, 37(7): 612-615.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.07.005

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I7/612

图/表 4

表1 两组一般资料比较

组别	例数	性别[例(%)]		病程 (月)	吸烟 [例(%)]
组别	例数	男	女	病程 (月)	吸烟 [例(%)]
PMR≤60岁组	24	16(66.7)	8(33.3)	12.92±5.37	6(25.0)
PMR>60岁组	44	17(38.6)	27(61.3)	11.75±4.31	8(18.1)
$t$ /χ²值		4.885		0.977	0.442
$P$ 值		0.042		0.332	0.542

表1 两组一般资料比较

组别	例数	性别[例(%)]		病程 (月)	吸烟 [例(%)]
组别	例数	男	女	病程 (月)	吸烟 [例(%)]
PMR≤60岁组	24	16(66.7)	8(33.3)	12.92±5.37	6(25.0)
PMR>60岁组	44	17(38.6)	27(61.3)	11.75±4.31	8(18.1)
$t$ /χ²值		4.885		0.977	0.442
$P$ 值		0.042		0.332	0.542

表2 两组临床表现比较[例(%)]

组别	例数	发热	体重减轻	晨僵	肩胛带肌痛	骨盆带肌痛	颈痛	腰痛
PMR≤60岁组	24	4(16.7)	6(25.0)	17(70.8)	21(87.5)	19(79.2)	8(33.3)	6(25.0)
PMR>60岁组	44	6(13.6)	14(31.8)	28(63.6)	41(93.1)	37(84.1)	5(11.4)	10(22.8)
χ²值		0.114	0.348	0.359	0.623	0.259	4.847	0.045
$P$ 值		0.736	0.592	0.602	0.658	0.741	0.050	1.000

表2 两组临床表现比较[例(%)]

组别	例数	发热	体重减轻	晨僵	肩胛带肌痛	骨盆带肌痛	颈痛	腰痛
PMR≤60岁组	24	4(16.7)	6(25.0)	17(70.8)	21(87.5)	19(79.2)	8(33.3)	6(25.0)
PMR>60岁组	44	6(13.6)	14(31.8)	28(63.6)	41(93.1)	37(84.1)	5(11.4)	10(22.8)
χ²值		0.114	0.348	0.359	0.623	0.259	4.847	0.045
$P$ 值		0.736	0.592	0.602	0.658	0.741	0.050	1.000

表3 两组实验室指标比较( x -±s)

组别	例数	ESR (mm/h)	CRP (mg/L)	Hb (g/L)	LDH (mmol/L)
PMR≤60岁组	24	63.92±7.66	35.39±15.79	119.13±6.89	214.33±70.9
PMR>60岁组	44	73.55±12.49	48.35±17.27	112.16±10.67	228.30±99.62
$t$ 值		-3.435	-3.047	3.258	-0.650
$P$ 值		0.001	0.003	0.002	0.518

表3 两组实验室指标比较( x -±s)

组别	例数	ESR (mm/h)	CRP (mg/L)	Hb (g/L)	LDH (mmol/L)
PMR≤60岁组	24	63.92±7.66	35.39±15.79	119.13±6.89	214.33±70.9
PMR>60岁组	44	73.55±12.49	48.35±17.27	112.16±10.67	228.30±99.62
$t$ 值		-3.435	-3.047	3.258	-0.650
$P$ 值		0.001	0.003	0.002	0.518

表4 两组治疗反应比较

组别	例数	单独糖皮质激素 [例(%)]	糖皮质激素累积剂量(mg)		复发 [例(%)]
			28天	84天
			PMR≤60岁组	24		4(16.7)	603.54±62.82	1278.08±125.48	6(25.0)
PMR>60岁组	44	6(13.6)	585.11±55.20	1243.98±127.72	23(52.3)
$t$ /χ²值		0.114	1.253	1.059	4.722
$P$ 值		0.736	0.294	0.294	0.041

表4 两组治疗反应比较

组别	例数	单独糖皮质激素 [例(%)]	糖皮质激素累积剂量(mg)		复发 [例(%)]
			28天	84天
			PMR≤60岁组	24		4(16.7)	603.54±62.82	1278.08±125.48	6(25.0)
PMR>60岁组	44	6(13.6)	585.11±55.20	1243.98±127.72	23(52.3)
$t$ /χ²值		0.114	1.253	1.059	4.722
$P$ 值		0.736	0.294	0.294	0.041

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