作者：王子韬，向婷，王文，谢建民

单位：

210011江苏省南京市，南京医科大学第二附属医院风湿免疫科 通信作者：谢建民，E-mail：xiejmdoc@163.com

Units：

Department of Rheumatology and Immunology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China Corresponding author: XIE Jianmin, E-mail: xiejmdoc@163.com

关键词：

类风湿关节炎; 间质性肺病; 高尿酸血症; 尿酸; 预测;

Keywords：

Rheumatoid arthritis; Interstitial lung disease; Hyperuricemia; Uric acid; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.036

Funds：

国家自然科学基金资助项目（81871279）

摘要：

背景类风湿关节炎(RA)常伴有血尿酸代谢异常,间质性肺病(ILD)是RA的常见关节外表现。目前国内外有关血尿酸水平与RA相关ILD(RA-ILD)关系的研究报道很少。目的 分析血尿酸与RA-ILD的关系。方法 回顾性选取2018年1月至2021年1月在南京医科大学第二附属医院住院的RA患者234例,根据是否并发ILD将其分为RA-ILD组57例和无RA-ILD组177例。采用倾向性评分匹配方法,通过1∶1最邻近匹配,最终匹配到57个对子。比较匹配后两组患者一般资料、实验室检查指标;RA患者并发ILD的影响因素分析采用多因素Logistic回归分析,绘制受试者工作特征(ROC)曲线以评估血尿酸对RA患者并发ILD的预测价值。匹配后RA患者血尿酸与一般资料及实验室检查指标的相关性分析采用Pearson相关分析或Spearman秩相关分析。结果 匹配后,RA-ILD组患者高尿酸血症发生率、血尿酸、类风湿因子(RF)、抗环瓜氨酸多肽(CCP)抗体滴度、抗CCP抗体阳性率、肌酐及胱抑素C高于无RA-ILD组(P<0.05)。多因素Logistic回归分析结果显示,高尿酸血症〔OR=2.883,95%CI(1.069,7.774)〕和RF〔OR=2.471,95%CI(1.088,5.613)〕是RA患者并发ILD的影响因素(P<0.05)。ROC曲线分析结果显示,血尿酸预测RA患者并发ILD的曲线下面积为0.728〔95%CI(0.652,0.804)〕,最佳截断值为330μmol/L,灵敏度为45.6%、特异度为91.5%。相关性分析结果显示,匹配后RA患者血尿酸与年龄、ILD、RF、尿素、肌酐和胱抑素C呈正相关,与血清镁、血红蛋白呈负相关(P<0.05)。结论 高尿酸血症是RA-ILD的危险因素,血尿酸对RA-ILD具有一定预测价值;RF、抗CCP抗体与血尿酸可能共同参与RA-ILD的发生。

Abstract：

【Abstract】　Background Rheumatoid arthritis (RA) is often accompanied by abnormal blood uric acid metabolism.Interstitial lung disease (ILD) is a common extraarticular manifestation of RA. At present, there are few reports on the relationshipbetween serum uric acid level and RA-associated ILD (RA-ILD) at home and abroad.Objective To analyze the relationshipbetween serum uric acid level and RA-ILD.Methods A total of 234 RA patients hospitalized in the Second Affiliated Hospitalof Nanjing Medical University from January 2018 to January 2021 were retrospectively selected. According to the presence orabsence of ILD, they were divided into RA-ILD group (n=57) and non-RA-ILD group (n=177) . Using propensity score matchingmethod and 1∶1 nearest neighbor matching, 57 pairs were finally matched. The general data and laboratory indexes of the twogroups were compared; multivariate Logistic regression analysis was used to analyze the influencing factors of ILD in RA patients,and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum uric acid level for ILDin RA patients. Pearson correlation analysis or Spearman rank correlation analysis was used to analyze the correlation betweenserum uric acid with general data and laboratory indexes of RA patients after matching. Results After matching, the incidence ofhyperuricemia, serum uric acid, rheumatoid factor (RF) , anti cyclic citrullinated peptide (CCP) antibody titer, anti CCP antibodypositive rate, creatinine and cystatin C in the RA-ILD group were higher than those in the non-RA-ILD group (P <0.05) .Multivariate Logistic regression analysis showed that hyperuricemia [OR=2.883, 95%CI (1.069, 7.774) ] and RF [OR=2.471,95%CI (1.088, 5.613) ] were the influencing factors of ILD in RA patients (P <0.05) . ROC curve analysis showed that the areaunder curve of serum uric acid level for predicting ILD in RA patients was 0.728 [95%CI (0.652, 0.804) ] , and the best cut-offvalue was 330 μmol/L, the sensitivity was 45.6%, and the specificity was 91.5%. The results of correlation analysis showed thatafter matching, serum uric acid was positively correlated with age, ILD, RF, urea, creatinine and cystatin C, and was negativelycorrelated with serum magnesium, hemoglobin in RA patients (P <0.05) . Conclusion Hyperuricemia is a risk factor for RAILD, and the serum uric acid level has a certain predictive value for RA-ILD; RF, anti CCP antibody and serum uric acid may beinvolved in the occurrence of RA-ILD.

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