强直性脊柱炎患者死亡相关因素有经济、合并症和髋关节置换术-上海强直医院

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强直性脊柱炎患者死亡相关因素有经济、合并症和髋关节置换术

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作者：Exarchou S, et al.

翻译：北京大学首钢医院丁艳（ding820626@163.com）

审校： 王宽婷

摘要：目的：目前关于强直性脊柱炎死亡率的研究很少。因此，本研究旨在评估：（1）强直性脊柱炎患者和普通人群的死亡率比较；（2）强直性脊柱炎患者死亡的影响因素。

方法： 来自全国疾病登记数据库的风湿科或内科门诊所诊断的强直性脊柱炎患者（n = 8600）为研究对象，来自于人口普查登记的一般人群为对照组（N = 40460），对照组与强直性脊柱炎患者的年龄、性别及地区相匹配。随访期限从2006年1月1日或疾病初次诊断开始，随访终点为死亡、移民或2012年12月31日。从疾病登记资料中的获取患者的社会经济因素、临床表现、关节手术、并发症和治疗药物。用Cox回归模型来确定强直性脊柱炎患者的死亡率和死亡影响因素。

结果： 强直性脊柱炎患者中有496例死亡，对症组中有1533例死亡。年龄和性别调整后的HR为1.60（95% CI 1.44至1.77），男性（年龄调整后的HR = 1.53，95% CI 1.36至1.72）和女性（年龄调整后的HR = 1.83，95% CI 1.50至2.22）患者的死亡率均增加。在强直性脊柱炎组，与死亡率相关的因素包括教育水平较低、常见的合并症（糖尿病、感染、心血管疾病、肺部疾病和恶性肿瘤）和髋关节置换手术。

结论：强直性脊柱炎患者中男性和女性患者的死亡率均增加。与死亡相关

的因素包括社会经济因素、常见的合并症和髋关节置换手术。

附原文：Objectives Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population.Methods Nationwide cohorts of patients with AS diagnosed at rheumatology or internal medicine outpatient clinics (n=8600) and age-matched, sex-matched and county-matched general population comparators (n=40 460) were identified from the National Patient Register and the census register, respectively. The follow-up period began on 1 January 2006 or at the first date of registered diagnosis thereafter and extended until death, emigration or 31 December 2012, whichever occurred first. Socioeconomic variables, AS-related clinical manifestations, joint surgery, comorbidities and medication were identified from other national registers. Cox regression models were used to determine mortality and predictors for death in the AS cohort. Results There were 496 deaths in the AS cohort and 1533 deaths in the control cohort resulting in an age-adjusted and sex-adjusted HR of 1.60 (95% CI 1.44 to 1.77), with increased mortality for men (age-adjusted HR=1.53, 95% CI 1.36 to 1.72) and women (ageadjusted HR=1.83, 95% CI 1.50 to 2.22). Within the AS cohort, statistically significant predictors for death were a lower level of education, general comorbidities (diabetes, infections, cardiovascular, pulmonary and malignant diseases) and previous hip replacement surgery. Conclusions Mortality was increased for male and female patients with AS. Predictors of death within the AS cohort included socioeconomic status, general comorbidities and hip replacement surgery.

引自：Exarchou S, et al. Mortality in ankylosing spondylitis: results from a nationwide population-based study . Ann Rheum Dis 2016;75:1466–1472

强直性脊柱炎诊疗新进展

强直性脊柱炎久治不愈与其本身病程复杂性有关，深层原因则是较长一段时间来，我国医疗政策对该病种的师资力量投入不足导致研究进展止步不前。如何改变这一现状？

专病专治，以“专”带“全”，国家医改近来做出多项举措，弥补综合性医院对慢性病投入不足的缺失。在国际化都市上海设立一座强直性脊柱炎专病专治医院，简称“上海强直医院”，受到原国家卫生部副部长孙隆椿的高度评价。