| 周芳芳,马龙新.类风湿关节炎并发颈动脉粥样硬化的影响因素及其风险预测模型构建与验证[J].安徽医药,2026,30(3):607-613. |
| 类风湿关节炎并发颈动脉粥样硬化的影响因素及其风险预测模型构建与验证 |
| Risk factors for rheumatoid arthritis complicated with carotid atherosclerosis and the construction and verification of a prediction model |
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| DOI：10.3969/j.issn.1009-6469.2026.03.036 |
| 中文关键词: 动脉粥样硬化 关节炎，类风湿 影响因素分析 类风湿因子 抗环瓜氨酸肽 C反应蛋白 基质金属蛋白酶-9 同型半胱氨酸 尿酸 高密度脂蛋白 列线图 受试者操作特征曲线 |
| 英文关键词: Atherosclerosis Arthritis, rheumatoid Root cause analysis Rheumatoid factor Anti-cyclic citrullinated peptide C-reactive protein Matrix metalloproteinase-9 Homocysteine Uric acid High-density lipoprotein Nomogram Receiver op. erating characteristic curve |
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| 中文摘要: |
| 目的探究类风湿关节炎( RA)并发颈动脉粥样硬化的影响因素，以此建立风险预测模型并验证其预测效能。方法回顾性分析盐城市第一人民医院 2018年 6月至 2022年 12月收治的 312例 RA病人的临床资料，采用随机数字表法按照 2∶1将其分为建模组( 208例)和验证组( 104例)。根据病人是否并发颈动脉粥样硬化将建模组分为并发组( 89例)和未并发组( 119例)。采用多因素 logistic回归分析探究 RA并发颈动脉粥样硬化的风险因素，采用 R 3.4.3软件包绘制列线图模型，采用 Boot. strap法进行内部验证，并采用受试者操作特征曲线( ROC曲线)和决策曲线分析( DCA)评价列线图模型的预测效能和临床净获益率。结果并发组 RA病程长于未并发组［5.19(3.07，7.31)年比 3.74(2.22，5.26)年， P<0.05］激素治疗 >5年［39.33%(35/ 89)比 21.85%(26/119)］、关节外受累［39.33%(35/89)比 21.01%(25/119)］、类风湿因子阳性［80.9，0%(72/89)比 66.39%(79/ 119)］、抗环瓜氨酸肽( CCP)抗体阳性［82.02%(73/89)比 62.18%(74/119)］占比与 C反应蛋白( CRP)［10.54(7.15，13.93)mg/L比 6.23(2.99，9.47)mg/L］、基质金属蛋白酶 -9(MMP-9)［(36.03±5.64)μg/L比( 33.56±4.56)μg/L］、肿瘤坏死因子 α(TNF-α)［(47.81± 4.14)ng/L比( 44.68±3.29)ng/L］、同型半胱氨酸( Hcy)［( 16.26±2.54)μmol/L比( 13.56±2.35)μmol/L］、红细胞沉降率［( 47.23± 9.85)mm/h比( 44.52±9.24)mm/h］、尿酸［(432.56±78.54)μmol/L比( 368.45±71.32)μmol/L］水平均高于未并发组(均 P<0.05)高密度脂蛋白( HDL)水平低于未并发组［( 1.05±0.34)mmol/L比( 1.23±0.26)mmol/L，P<0.05］；经多因素 logistic回归分析可知，，关节外受累、病程长、抗 CCP抗体阳性以及高 CRP、高 MMP-9、高 TNF-α、高 Hcy、高尿酸均是 RA病人并发颈动脉粥样硬化的危险因素( OR=2.29、1.36、3.42、2.48、1.26、1.94、2.27、1.42，P<0.05)高 HDL为其保护因素(OR=0.76，P<0.05)。依据以上影响因素构建 RA病人并发颈动脉粥样硬化的列线图模型，经 Bootstrap法验，证建模组、验证组的一致性指数为 0.825、0.822，校正曲线和标准曲线拟合度较好； ROC曲线结果显示，建模组列线图预测 RA病人并发颈动脉粥样硬化的曲线下面积为 0.88［95%CI:(0.83，0.92)］验证组预测的曲线下面积为 0.84［95%CI:(0.76，0.91)］； DCA显示建模组在风险阈值 0.08~1.00时可获得净收益，验证组在风险阈值为 0.09~0.90及 0.92~1.00时可获得净收益。结论关节外受累、病程长、抗 CCP抗体阳性以及高 CRP、高 MMP-9、高 TNF-α、高 Hcy、高尿酸均是 RA病人并发颈动脉粥样硬化的危险因素，高 HDL为其保护因素，依据风险因素构建的列线图模型临床应用价值较高。 |
| 英文摘要: |
| Objective To explore the risk factors for rheumatoid arthritis (RA) complicated with carotid atherosclerosis, and to estab.lish a risk prediction model and verify its predictive efficacy.Methods The clinical data of 312 RA patients admitted to YanchengFirst People's Hospital from June 2018 to December 2022 were retrospectively analyzed. They were assigned into a modeling group (n= 208) or a validation group (n=104) according to the ratio of 2:1 by random number table method. According to whether the patients hadcarotid atherosclerosis, the modeling group was divided into concurrent group (n=89) and non-concurrent group (n=119). Multivariatelogistic regression was used to analyze the risk factors for RA complicated with carotid atherosclerosis, and R 3.4.3 software packagewas used to draw the nomogram model, and Bootstrap method was used for internal verification. The predictive performance and clini.cal net benefit rate of the nomogram model were evaluated by the receiver operating characteristic curve (ROC curve) and decisioncurve analysis (DCA).Results The course of RA in the concurrent group was longer than that in the non-concurrent group [5.19 (3.07, 7.31) years vs. 3.74 (2.22, 5.26) years, P<0.05], the proportions of hormone therapy>5 years [39.33% (35/89) vs. 21.85% (26/119)], ex. trarthral involvement [39.33% (35/89) vs. 21.01% (25/119)], rheumatoid factor positive [80.90% (72/89) vs. 66.39% (79/119)], positive anti-cyclic citrullinated peptide (CCP) antibody [82.02% (73/89) vs. 62.18% (74/119)] and the levels of C-reactive protein (CRP) [10.54 (7.15, 13.93) mg/L vs. 6.23 (2.99, 9.47) mg/L], matrix metalloproteinase-9 (MMP-9) [(36.03±5.64) μg/L vs. (33.56±4.56) μg/L], tumor necrosis factor α (TNF-α) [(47.81±4.14) ng/L vs. (44.68±3.29) ng/L], homocysteine (Hcy) [(16.26±2.54) μmol/L vs. (13.56±2.35) μmol/ L], erythrocyte precipitation rate [(47.23±9.85) mm/h vs. (44.52±9.24) mm/h], uric acid [(432.56±78.54) μmol/L vs. (368.45±71.32) μmol/L] were higher than those in the uncomplicated group (P<0.05), and the level of high-density lipoprotein (HDL) was lower than that in the non-concurrent group [(1.05±0.34) mmol/L vs. (1.23±0.26) mmol/L, P<0.05]. Multivariate logistic regression analysis results showed that extra-articular involvement, long course of disease, positive anti-CCP antibody, high CRP, high MMP-9, high TNF-α, high Hcy and high uric acid were risk factors for carotid atherosclerosis in RA patients (OR=2.29, 1.36, 3.42, 2.48, 1.26, 1.94, 2.27, 1.42, P< 0.05), and high HDL was a protective factor (OR=0.76, P<0.05). Based on the above risk factors, a nomogram model of RA patientscomplicated with carotid atherosclerosis was constructed. The Bootstrap-validated concordance index was 0.825 for the modeling groupand 0.822 for the validation group, and the calibration curve and standard curve were well fitted. The ROC curve results showed thatthe area under the curve of the nomogram for predicting carotid atherosclerosis in RA patients was 0.88 [95%CI: (0.83, 0.92)], and the area under the curve of the validation group was 0.84 [95%CI: (0.76, 0.91)]. The DCA curve showed that the modeling group could ob.tain net income when the risk threshold was between 0.08 and 1.00, and the validation group could obtain net income when the riskthresholds were within 0.09-0.90 and 0.92-1.00. Conclusions The extra-articular involvement, long course of disease, positive anti-CCP antibody, high CRP, high MMP-9, high TNF-α, high Hcy and high uric acid are risk factors for carotid atherosclerosis in RA pa.tients, while high HDL is a protective factor. The nomogram model based on risk factors has high clinical application value. |
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