强直性脊柱炎合并低高密度脂蛋白血症的临床特征及影响因素分析

背景　强直性脊柱炎（AS）患病率高、致残率高，是较严重的公共卫生问题，临床发现AS患者合并低高密度脂蛋白血症的患病率较正常人高。目的　了解AS合并低高密度脂蛋白血症患者的临床特征，并分析其影响因素。方法　采用回顾性研究的方法，收集2016-01-01至2017-06-30在中日友好医院中医风湿病科住院的18~60周岁的266例AS患者的临床资料。根据AS患者的高密度脂蛋白水平，将其分为AS合并低高密度脂蛋白血症组及AS组，比较两组间的差异。采用多因素Logistic回归分析AS合并低高密度脂蛋白血症的影响因素。结果　共纳入266例患者，其中AS合并低高密度脂蛋白血症组179例（67.3%），AS组87例（32.7%）。两组性别、年龄、发病年龄、体质指数（BMI）、红细胞沉降率（ESR）、C反应蛋白（CRP）、总胆固醇、三酰甘油水平、有无家族史、炎性反应类型、人白细胞抗原B27（HLA-B27）基因分型比较，差异均有统计学意义（P<0.05）；两组起病病程、确诊病程、低密度脂蛋白水平、HLA-B27基因阳性率比较，差异均无统计学意义（P>0.05）。多因素Logistic回归分析结果显示，性别〔OR=9.453，95%CI（3.692，24.203）〕、总胆固醇〔OR=0.308，95%CI（0.181，0.524）〕、三酰甘油水平〔OR=8.431，95%CI（3.334，21.332）〕、家族史〔OR=4.932，95%CI（1.586，15.343）〕、炎性反应类型〔OR=3.148，95%CI（1.325，7.478）〕是AS患者合并低高密度脂蛋白血症的影响因素（P<0.05）。结论　AS合并低高密度脂蛋白血症具有患病率高、男性居多、发病年龄早、炎性因子水平高、家族史阳性率高、以急性炎性反应居多等特征，存在BMI增高、血脂异常等代谢综合征倾向；男性、总胆固醇水平降低、三酰甘油水平升高、有AS家族史、急性炎性反应均为AS合并低高密度脂蛋白血症的危险因素。

Clinical Characteristics and Influencing Factors of Ankylosing Spondylitis with Hypo-high-density Lipoproteinemia

Background　Ankylosing spondylitis （AS） is a serious public health problem with high rates of morbidity and disability.Clinical studies show that the prevalence of hypo-high-density lipoproteinemia（hypo-HDL） is higher in AS patients than that of normal people.Objective　To explore the clinical characteristics and influencing factors of AS with hypo-HDL.Methods　This retrospective study was conducted in 266 consecutive AS patients aged 18-60 who were hospitalized in Department of TCM Rheumatology，China-Japan Friendship Hospital from January 1，2016 to June30，2017.Participants with hypo-HDL and those without were assigned to AS with hypo-HDL group and AS group，respectively.Clinical characteristics were compared between the groups.Multivariate Logistic regression analysis was performed to identify the influencing factors of AS with hypo-HDL.Results　Of the 266 cases，there were 179（67.3%） with hypo-HDL，and other 87 （32.7%）without.There were significant differences in the distribution of sex，average age，age of onset，body mass index （BMI），erythrocyte sedimentation rate （ESR），C-reactive protein （CRP），total cholesterol（TC），triglyceride（TG），family history of AS，type of inflammatory response and HLA-B27 genotype between the two groups （P<0.05）．The average course of onset，course of diagnosis，and low-density lipoprotein，and HLA-B27 positive rate did not differ significantly between the groups （P>0.05）．Multivariate Logistic regression analysis showed that sex 〔OR=9.453，95%CI（3.692，24.203）〕，TC〔OR=0.308，95%CI（0.181，0.524）〕，TG level〔OR=8.431，95%CI（3.334，21.332）〕，family history of AS〔OR=4.932，95%CI（1.586，15.343）〕，inflammatory response type〔OR=3.148，95%CI（1.325，7.478）〕were the influencing factors of AS with hypo-HDL （P<0.05）．Conclusion　AS with hypo-HDL had the characteristics of high morbidity，male predominance，early onset age，high level of inflammatory markers，high prevalence of family history of AS，high prevalence of acute inflammations，and is possibly associated with increased BMI and dyslipidemia and other metabolic syndrome.Male，decreased TC and increased TG，family history of AS，and acute inflammation are risk factors for AS with hypo-HDL.