【摘要】 目的 探讨首诊类风湿关节炎(rheumatoid arthritis, RA)患者伴肝功能损伤的危险因素及预后。方法 选取2021年1月—2024年12月在青海大学附属医院首诊为RA且从未治疗的患者172例，并选取同期健康体检者70例，进一步将首诊RA的患者按是否伴肝功能损伤分为RA伴肝功能损伤组74例，肝功能正常组98例，通过回顾性研究及队列研究的方法，探讨首诊RA患者伴肝功能损伤的危险因素并分析预后。结果 (1)RA组丙氨酸转氨酶(alanine aminotransferase, ALT)、天冬氨酸转氨酶(aspartate aminotransferase, AST)、碱性磷酸酶(alkaline phosphatase, ALP)、γ-谷氨酰转移酶(gamma-glutamyl transferase, GGT)、白细胞计数(white blood cell, WBC)、血小板(platelet, PLT)、红细胞沉降率(erythrocyte sedimentation rate, ESR)及C反应蛋白(C-Reactive Protein, CRP)高于健康对照组(P<0.05)。(2)男性RA患者更容易合并肝功能损害(P<0.001),且肝功能异常RA患者的WBC计数高于肝功能正常RA患者(P=0.004);肝功能异常RA患者的PLT计数低于肝功能正常RA患者(P=0.032)。(3)在肝功能异常RA组中WBC计数与AST(r=-0.258,P=0.026)及ALB(r=-0.393,P=0.001)呈负相关趋势，PLT计数与ALB(r=-0.367,P=0.001)及TBil(r=-0.290,P=0.012)呈负相关趋势。(4)男性(OR=3.205,95%CI:1.310～7.838,P=0.011)、WBC计数升高(OR=1.392,95%CI:1.091～1.776,P=0.008)是RA患者合并肝损害的危险因素，而PLT计数升高(OR=0.989,95%CI:0.983～0.995,P=0.001)是RA患者合并肝损害的保护因素。(5)首诊RA伴肝功能损害的患者第一次住院距离再次住院的中位时间(8个月)明显短于不伴有肝功能损害的首诊RA患者(12个月)。通过构建Cox多因素分析发现，首诊时发现肝功能异常是影响RA患者再次住院的独立危险因素。结论 肝脏可能是RA的靶器官之一，RA可能导致肝脏受累及肝功能损伤，首诊RA伴有肝功能损害的患者可能有更差的预后，这对临床医生评估RA患者的预后具有一定的借鉴意义。更多还原

【Abstract】 Objective To investigate the risk factors and prognosis of patients with newly diagnosed rheumatoid arthritis(RA) complicated by liver injury. Methods A total of 172 patients with newly diagnosed RA who were not treated were collected from the Affiliated Hospital of Qinghai University(RA group) from January 2020 to December 2024, and 70 healthy physical examinees were collected during the same period(healthy control group). The patients with newly diagnosed RA were further divided into RA and liver injury subgroup(n=74) and RA and normal liver function subgroup(n=98) according to presence or absence of liver injury. A retrospective cohort study was performed on risk factors and prognosis of liver injury in patients with newly diagnosed RA. Results Alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), gamma-glutamyl transferase(GGT), white blood cell(WBC), platelet(PLT), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP)were higher in the RA group than in the healthy control group(P<0.05). Male RA patients were more likely to be complicated with liver injury(P<0.001), and the WBC count in RA patients with abnormal liver function was higher than that in patients with normal liver function(P=0.004), while the PLT count in patients with abnormal liver function was lower than that in patients with normal liver function(P=0.032). In the RA group with abnormal liver function, WBC count was negatively correlated with AST(r=-0.258, P=0.026) and ALB(r=-0.393, P=0.001), and PLT count was negatively correlated with ALB(r=-0.367, P=0.001) and TBil(r=-0.290, P=0.012). Male gender(OR=3.205, 95%CI: 1.310-7.838, P=0.011), and increased WBC count(OR=1.392, 95%CI: 1.091-1.776, P=0.008) were risk factors for liver injury in RA patients, while increased PLT count(OR=0.989, 95%CI: 0.983-0.995, P=0.001) was a protective factor for liver injury in RA patients. The median time(8 months) between first hospitalization and re-hospitalization in patients with newly diagnosed RA and liver injury was significantly shorter than that in patients with newly diagnosed RA but without liver injury. By constructing Cox multivariate analysis, it was found that abnormal liver function was an independent risk factor affecting the re-hospitalization of RA patients. Conclusion Liver may be one of the target organs of RA. RA may directly lead to liver involvement and liver injury, and patients with newly diagnosed RA complicated by liver injury may have worse prognosis, which has certain reference significance for clinicians to evaluate the prognosis of patients with RA.更多还原