Disease activity as a risk factor for venous thromboembolism in rheumatoid arthritis analysed using time-averaged DAS28CRP: a nested case-control study
Disease activity as a risk factor for venous thromboembolism in rheumatoid arthritis analysed using time-averaged DAS28CRP: a nested case-control study
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DOI：
10.1007/s00296-022-05121-4
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发表时间：
2022-04-06
影响因子：
4
通讯作者：
Atsumi, Tatsuya
中科院分区：
文献类型：
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作者：
Yoshimura, Masaru;Fujieda, Yuichiro;Atsumi, Tatsuya
本研究的目的是阐明类风湿关节炎（RA）患者静脉血栓栓塞（VTE）的临床特征和危险因素。我们回顾性分析了2010年至2019年在北海道大学医院就诊并随访超过2年的RA患者的VTE患病率。为探讨发生VTE的危险性，我们通过密度抽样选择了260例无VTE（非VTE）的RA患者，并通过多因素Logistic回归分析确定了VTE的危险因素。单因素条件Logistic回归分析显示年龄较大（p < 0.0001，比值比[OR] 1.08，95%置信区间[CI] 1.04-1.14），体重指数（BMI）增加（p = 0.001，OR 1.17，95% CI 1.06-1.31），RA相关肺部疾病的患病率较高（p = 0.002，OR 2.10，95% CI 1.33-3.30）和更频繁使用糖皮质激素（p = 0.001，OR 2.09，95% CI 1.34-3.51）与VTE的发生显著相关。此外，具有较高的时间平均疾病活动性评分28（DAS 28）CRP的患者风险升高（p < 0.0001，OR 3.25，95% CI 1.94-6.12）。在条件多变量logistic回归分析中，时间平均DAS 28 CRP与VTE的发生显著相关（p = 0.0001，校正OR 3.40，95% CI 1.77-7.85）。疾病活动性是RA患者发生VTE的主要危险因素，提示持续的临床缓解可能有利于降低VTE的风险。
The objective of this study is to clarify the clinical features and risk factors of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA). We retrospectively reviewed the prevalence of VTE in RA patients who visited Hokkaido University Hospital from 2010 to 2019 and had more than 2 years of follow-up. To explore the risk to develop VTE, we selected 260 RA patients without VTE (non-VTE) via density sampling and identified the risk factors for VTE by multivariate logistic regression analysis. Univariate conditional logistic regression analysis showed older age (p < 0.0001, Odds Ratio [OR] 1.08, 95% Confidence Interval [CI] 1.04-1.14), increase of the body mass index (BMI) (p = 0.001, OR 1.17, 95% CI 1.06-1.31), higher prevalence of RA-associated lung disease (p = 0.002, OR 2.10, 95% CI 1.33-3.30) and more frequent glucocorticoid usage (p = 0.001, OR 2.09, 95% CI 1.34-3.51) in RA patients was associated with the development of VTE significantly. Furthermore, patients with higher time-averaged disease activity score 28 (DAS28) CRP were at elevated risk (p < 0.0001, OR 3.25, 95% CI 1.94-6.12). In conditional multivariate logistic regression analysis, time averaged DAS28CRP was significantly associated with the development of VTE (p = 0.0001, adjusted OR 3.40, 95% CI 1.77-7.85). Disease activity was identified as a major risk factor of VTE in patients with RA, suggesting that sustained clinical remission could be beneficial for decrease the risk of VTE.