Arthr & Rheu：风险评分可预测风湿性关节炎病人患严重感染几率

风湿性关节炎（Rheumatoid arthritis）不仅仅使患者痛苦、使患者残疾，而且可以引发患者高的死亡风险。对于感染的高度敏感性以及伴随着自体免疫障碍是该病高死亡风险的一个原因。近日来自梅奥诊所的研究者发现了，风险评分可以用来预测病人患严重感染的几率，这项评分的信息包括：风湿性关节炎如何影响病人、病人的年龄、皮质类固醇的使用以及其它疾病是否存在等。

相关研究成果刊登在了国际著名杂志Arthritis & Rheumatism上。

研究者分析了在1955年至1994年期间诊断的584名风湿性关节炎病人的医疗记录，并且跟踪研究直到2000年的1月份。在调查的人群中，有252人或者说是一半儿人都有不止一种感染疾病的存在，他们需要进行住院治疗或者静脉注射治疗，这些人群总共积累了646次感染。

研究小组基于对风湿性关节炎患者的研究，开发出了一种新型的感染风险评分体系，这项计算中的因子包括：年龄、之前是否有严重感染疾病、皮质类固醇的使用、低的白细胞数量；在血液测试中的结果可以用来检测炎症标志物，称为红细胞沉降速度比率，这是类风湿性关节炎关节外的标记，以及确定其它严重情况是否存在，比如心脏疾病、心衰、糖尿病、肺病、血管疾病或者酒精中毒等。

使用这种风险评分可以提醒医生们其病人有高的感染风险以及需要更为频繁的跟踪治疗以及疾病的预防感染和治疗。风湿性关节炎病人面临更高的感染风险，而且这种风险并不仅仅是因为关节炎药物的服用。

更多的研究需要进行，来决定那些获得最好用药的病人的感染风险水平，以及感染风险如何影响风湿性关节炎患者的药物使用（这种药物为疾病-修饰抗风湿药物或者DMARDs）。相关研究成果由基因泰克公司、国家关节炎、骨骼肌皮肤疾病研究中心等机构提供资助.

编译自：Infections in Rheumatoid Arthritis Patients: Study Finds Way to Pinpoint Risk

doi:10.1002/art.34530
PMC:
PMID:

Development and validation of a risk score for serious infection in patients with rheumatoid arthritis

Cynthia S. Crowson*, Deana D. Hoganson, Patrick D. Fitz-Gibbon, Eric L. Matteson†

Objective Infection risk is increased in patients with rheumatoid arthritis (RA), and accurate assessment of the risk of infection could inform clinical decision-making. This study was undertaken to develop and validate a score to predict the 1-year risk of serious infection in patients with RA. Methods We studied a population-based cohort of Olmsted County, Minnesota residents with incident RA ascertained in 1955–1994 whose members were followed up longitudinally, via complete medical records, until January 2000. The validation cohort included residents with incident RA ascertained in 1995–2007. The outcome measure included all serious infections (requiring hospitalization or intravenous antibiotics). Potential predictors were examined using multivariable Cox models. The risk score was estimated directly from the multivariable model, and performance was assessed in the validation cohort using Harrell's C statistic. Results Among the 584 RA patients in the original cohort (72% female; mean age 57.5 years), who were followed up for a median of 9.9 years, 252 had ≥1 serious infection (646 total infections). Components of the risk score included age, previous serious infection, corticosteroid use, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and comorbidities (coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes mellitus, alcoholism). Validation analysis revealed good discrimination (C statistic 0.80). Conclusion RA disease characteristics and comorbidities can be used to accurately assess the risk of serious infection in patients with RA. Knowledge of risk of serious infection in RA patients can influence clinical decision making and inform strategies to reduce and prevent the occurrence of these infections.