合并2型糖尿病对类风湿关节炎疗效的影响

目的探讨类风湿关节炎（RA）并发2型糖尿病（T2DM）患者的临床疗效。 方法回顾性分析2016年1月至2019年12月在宿迁市第一人民医院就诊的RA患者，按照是否并发T2DM分为合并T2DM组和无T2DM组，收集2组患者的一般资料、治疗药物、治疗前后病情活动指数、治疗反应率，采用Mann-Whitney U检验或非参数秩和检验比较年龄、病程、体质量指数（BMI）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、类风湿因子（RF）、抗环瓜氨酸肽（CCP）抗体、红细胞沉降率（ESR）、C反应蛋白（CRP）、疾病活动性评分系统（DAS28）评分和疼痛视觉模拟量表（VAS）评分等的组间差异，采用χ²检验比较性别和药物使用情况的组间差异，FBG与DAS28评分的相关性采用Pearson相关分析法。 结果与无T2DM组相比，合并T2DM组患者年龄、BMI、FBG、HbA1c、ESR、DAS28、VAS水平均较高[（61.09±8.03）岁vs（54.01±12.32）岁；（24.20±3.96）kg/m² vs（22.95±3.66）kg/m²；（8.08±2.39）mmol/L vs（5.18±0.85）mmol/L；（7.51±1.45）% vs（5.41±0.55）%；（74.43±35.94）mm/h vs（62.38±32.05）mm/h；（6.07±1.41）分vs（5.49±1.87）分；（5.28±1.36）分vs（4.50±1.48）分]，差异均具有统计学意义（Z=-3.794、-2.04、-8.8593、-8.936、-2.054、-3.359、-3.142，P<0.001、=0.041、<0.001、<0.001、=0.040、=0.001、=0.002），而在性别、病程、RF、抗CCP抗体、CRP方面2组比较，差异无统计学意义（P均>0.05）。在治疗药物上，合并T2DM组甲氨蝶呤使用率较低（44.68% vs 62.90%），雷公藤多苷使用率较高（80.85% vs 47.85%），差异具有统计学意义（χ²=5.159、16.479，P=0.023、<0.001），2组在非甾体抗炎药、来氟米特、硫酸羟氯喹、艾拉莫德、生物制剂及联合用药方面比较，差异无统计学意义（P均>0.05）。在病情评估方面，2组患者随访时ESR、CRP、DAS28、VAS水平及病情评估等级均较基线明显下降，差异均具有统计学意义（P均<0.01），合并T2DM组治疗前疾病活动指数更高。在血糖控制方面，合并T2DM组随访时的FBG较基线值降低[（6.26±1.00）mmol/L vs（8.08±2.39）mmol/L]，血糖达标率明显升高（42.55% vs 12.77%），差异具有统计学意义（Z=-4.816，P<0.001；χ²=10.421，P<0.001）；在治疗反应上，2组治疗反应良好率及总体治疗反应差异均无统计学意义（P均>0.05）；相关性分析显示合并T2DM组治疗前后的DAS28水平与FBG均存在相关性（r=0.305、0.368，P=0.037、0.011）。 结论合并T2DM的RA患者病情活动度更高；是否合并T2DM不影响RA患者的疗效；RA患者病情缓解有助于提高T2DM的血糖达标率。

Effects of type 2 diabetes mellitus on curative effect of rheumatoid arthritis

ObjectiveTo investigate the curative effect of rheumatoid arthritis (RA) complicated with type 2 diabetes mellitus (T2DM). MethodsA retrospective analysis was performed on RA patients admitted to our hospital from January 2016 to December 2019. According to whether they had T2DM or not, the patients were divided into a T2DM group or non-T2DM group. General information, treatment drugs, disease activity index, and therapeutic response rate were collected. Mann-Whitney U test or non-parametric rank sum test was used for comparison of age, course of disease, body mass index (BMI), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), rheumatoid factor, anti-cyclic citrulline peptide (CCP) antibody, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity scoring system (DAS28) score, and pain visual analogue scale (VAS) score between groups, chi-square test was used for comparison of categorical data, and Pearson analysis was used for detecting the correlation between FBG and DAS28 score. ResultsCompared with patients without T2DM, patients with T2DM had higher age [(61.09±8.03) years vs (54.01±12.32) years], BMI [(24.20±3.96) kg/m² vs (22.95±3.66) kg/m²], FBG [(8.08±2.39) mmol/L vs (5.18±0.85) mmol/L], HbA1c [(7.51±1.45)% vs (5.41±0.55)%], ESR [(74.43±35.94) mm/h vs (62.38±32.05) mm/h], DAS28 score [(6.07±1.41) vs (5.49±1.87)], and VAS score [(5.28±1.36) vs (4.50±1.48)], and the differences were statistically significant (Z=-3.794, -2.04, -8.8593, -8.936, -2.054, -3.359, and -3.142; P<0.001, =0.041, <0.001, <0.001, =0.040, =0.001, and =0.002, respectively), while there were no statistically significant differences in gender, course of disease , RF, anti-CCP antibody, or RP (P>0.05). In terms of the treatment drugs, the rate of MTX use was significantly lower (44.68% vs 62.90%, χ²=5.159, P=0.023) and that of Tripterygium polyglycoside was significantly higher (80.85% vs 47.85%, χ²=16.479, P<0.001) in the T2DM group. There were no statistically significant differences in the use of nonsteroidal anti-inflammatory drugs, leflunomide, hydroxychloroquine sulfate, iguratimod, biological preparation, or combination medication between the two groups (P>0.05). The levels of ESR, CRP, DAS28, VAS score, and disease grade decreased significantly in both groups compared with the baseline values (P<0.01), while disease activity index of patients in the T2DM group was higher than that before treatment. In terms of blood glucose control, FBP in the T2DM group was significantly lower than the baseline value [(6.26±1.00) mmol/L vs (8.08±2.39) mmol/L, Z=-4.816, P<0.001], and the blood glucose compliance rate was significantly increased (42.55% vs 12.77%, χ²=10.421, P<0.001). The rate of good response to treatment and the overall response rate did not differ significantly between the two groups (P>0.05). Correlation analysis showed that there was a correlation between DAS28 level and fasting glucose in the T2DM group before and after treatment (r=0.305 and 0.368; P=0.037 and 0.011, respectively). ConclusionPatients with RA complicated with T2DM have higher disease activity. The combination of T2DM does not affect the therapeutic efficacy in RA patients. Remission in RA patients is helpful to improve the glycemic compliance rate of T2DM.