来源：风湿病与关节炎,2020,9（7）:7-10.

类风湿关节炎患者凝血指标变化及相关性分析（临床研究）

高金栋¹，刘　健²，忻　凌²，贺明玉¹，韩馨悦¹

　　【摘　要】目的：基于数据挖掘方法探究类风湿关节炎患者凝血指标的变化及其与免疫、炎症、代谢等指标的相关性。方法：收集并整理2012年8月至2019年3月在安徽中医药大学第一附属医院风湿免疫科就诊的类风湿关节炎住院患者的病历资料，采用SPSS 23.0软件对患者的凝血指标［凝血酶原时间（PT）、部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、D-二聚体（DD）］、免疫指标［类风湿因子（RF）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、免疫球蛋白G（IgG）、补体C3、补体C4］、炎症指标［红细胞沉降率（ESR）、抗链球菌溶血素“O”（ASO）、超敏C-反应蛋白（hs-CRP）］及脂代谢指标［甘油三酯（TG）、总胆固醇（TC）］进行相关性分析、Logistic回归分析及关联规则分析。结果：①共纳入类风湿关节炎患者1564例，其中DD升高者1173例（75.00%），FIB升高者792例（50.63%）。②相关性分析表明：DD与RF、hs-CRP、ESR、IgA、IgG、IgM、补体C3呈正相关（P < 0.05），与TG、TC呈负相关（P < 0.05）；FIB与RF、hs-CRP、IgA、IgM、补体C3、补体C4呈正相关（P < 0.05），与TG呈负相关（P < 0.05）；APTT与ASO、hs-CRP、ESR、IgG呈正相关（P < 0.05），与补体C3、TG、TC呈负相关（P < 0.05）。③二元Logistic回归分析得出：ESR、hs-CRP、IgA、IgG是DD升高的危险因素（OR > 1）；TG、TC是APTT升高的危险因素（OR > 1）；TC是PT降低的危险因素（OR > 1）；hs-CRP、ESR、IgM是FIB升高的危险因素（OR > 1）。④关联规则分析：设定最小置信度为70%，最小支持度为10%，提取支持度、置信度较高的指标。其中与DD升高关联较高的指标是ESR、RF、hs-CRP；与APTT升高关联较高的指标是ESR、RF；与FIB升高关联较高的指标是ESR、hs-CRP、RF。结论：类风湿关节炎患者存在高凝状态，主要表现在DD、FIB、APTT升高，并与炎症免疫脂代谢指标密切相关，其中TG、TC、hs-CRP、ESR、IgA、IgG、IgM是类风湿关节炎患者高凝状态的危险因素。

　　【关键词】　关节炎，类风湿；数据挖掘；凝血指标；凝血-纤维系统；相关性

Changes of Coagulation Indexes in Patients with Rheumatoid Arthritis and Correlated Analysis

GAO Jin-dong,LIU Jian,XIN Ling,HE Ming-yu,HAN Xin-yue

　　【ABSTRACT】Objective:To explore the changes of coagulation indexes in patients with rheumatoid arthritis（RA）and their correlation with immune,inflammatory and metabolic indexes based on data mining method.Methods:The medical records of patients with RA in the First Affiliated Hospital of Anhui University of Chinese Medicine from August 2012 to March 2019 were collected and sorted out.Software 23.0 was used for correlation analysis,logistic regression analysis and association rule analysis about PT,APTT,FIB,TT,DD,RF,IgA,IgM,IgG,C3,C4,ESR,ASO,hs-CRP,TG and TC.Results:A total of 1564 patients with RA were included,including 1173 cases（75.00%）with increased DD and 792 cases（50.63%）with elevated FIB.② Correlation analysis showed that DD was positively correlated with RF,hs-CRP,ESR,IgA,IgG,IgM and C3（P < 0.05）,and negatively correlated with TG and TC（P < 0.05）;FIB was positively correlated with RF,hs-CRP,IgA,IgM,C3,and C4（P < 0.05）,and negatively correlated with TG（P < 0.05）;APTT was positively correlated with ASO,hs-CRP,ESR and IgG（P < 0.05）and negatively correlated with C3,TG and TC（P < 0.05）.③ Binary Logistic regression analysis showed that ESR,hs-CRP,IgA and IgG were the risk factors for the increase of DD（OR > 1）;TG and TC were the risk factors for the increase of APTT（OR > 1）;TC was the risk factor for the decrease of PT（OR > 1）;hs-CRP,ESR and IgM were the risk factors of elevated FIB（OR > 1）.④ Association rule analysis:set the minimum confidence level as 70% and the minimum support degree as 10%,and extract the indicators with high support and confidence.Among them,ESR,RF and hs-CRP are the indicators with high correlation with DD;ESR and RF are closely related to the increase of APTT;ESR,hs-CRP and RF are highly associated with the increase of FIB.Conclusion:There is a hypercoagulable state in patients with RA,mainly manifested in the increase of DD,FIB,APTT,which are closely related to inflammatory immune lipid metabolism indexes.TG,TC,hs-CRP,ESR,IgA,IgG,and IgM are the risk factors of the hypercoagulable state.

　　【Keywords】 arthritis,rheumatoid;data mining;coagulation indicators;coagulation fiber system;correlation