老年类风湿关节炎患者心功能变化及其相关性研究

Cardiac function changes of aged rheumatoid arthritis and the correlation

目的:研究老年类风湿关节炎(RA)患者心功能变化及与他指标的相关性。方法:将68例类风湿关节炎(RA)患者按年龄分为中青年类风湿关节炎(YMRA)、老年类风湿关节炎(ERA)两组,采用超声心动图(UCG)检测两组RA患者的心功能,并与20例健康对照(NC)组比较;观察两组RA患者的疾病活动度评分(DAS-28)及临床症状、体征及实验室指标的变化。结果:①与NC组相比,两组RA患者舒张早期血流峰值(E峰)、短轴缩短率(FS,%)、E/A比值均显著降低(P<0.05或P<0.01);与YMRA组相比,ERA组患者E峰、E/A比值显著降低(P<0.05或P<0.01),舒张晚期血流峰值(A峰)显著升高(P<0.05)。②与YMRA组相比,ERA组病程、收缩压、DAS-28积分、关节肿胀积分、关节压痛积分、PLT、PCT、UA、α-AGP、hs-CRP、ESR显著升高(P<0.05或P<0.01);双手握力、CD4+CD25+Treg、CD4+CD25+CD127-Treg显著降低(P<0.05)。③Spearman相关分析显示,ERA组心功能参数E峰与年龄、DAS-28、α-AGP、CRP,E/A比值与收缩压,(EF,%)与类风湿因子,ST段压低数与年龄均呈呈显著负相关(P<0.05)。E峰与CD4+CD25+Treg,A峰与舒张压、15m步行时间,E/A比值与CD4+CD25+Treg均呈显著正相关(P<0.05)。结论:RA患者存在心功能下降,ERA患者心功能水平下降更为显著;UCG下表现为E峰、E/A、(EF,%)、(FS,%)的显著降低,A峰显著升高;ERA患者心功能参数与年龄、血压、实验室指标等相关。

Objective：To study the elderly patients with rheumatoid arthritis（ERA） of cardiac function changes and the correlation.Methods：68 RA patients were divided into two groups.One was young and middle-aged patients with rheumatoid arthritis（YMRA）,and another was ERA.We used UCG to observe the changes of cardiac function in RA and compare with normal control（NC） group;observe the disease activity score（DAS-28） and change of signs,laboratory indicators.Results：1.Compared with the NC group,RA patients with E peak,fractional shortening（FS,%） were significantly lower（P0.05 or P0.01）.Compared with YMRA,ERA patients E peak,E/A ratio was significantly lower（P0.05 or P0.01）,A peak was significantly higher（P0.05）.2.Compared with the YMRA,ERA duration,systolic blood pressure,joint swelling,joint tenderness,PLT,PCT,UA,a-AGP,hs-CRP,ESR were significantly higher（P0.05 or P0.01）;CD4＋CD25＋Treg,CD4＋CD25 ＋CD127-Treg were significantly lower（P0.05）.3.Spearman correlation analysis showed that,ERA cardiac function in patients with age,E peak,DAS-28,a-AGP,hs-CRP,E/A integral ratio and systolic blood pressure,EF,% points and RF,ST segment depression number and age showed a significant negative correlation（P0.05 or P0.01）.peak E and CD4＋CD25＋Treg,A peak and 15m walking time,diastolic blood pressure,E/A ratio of CD4＋CD25＋Treg,ST segment depression number and heart rate,diastolic blood pressure were significantly positively correlated（P0.05）.Conclusion：There was cardiac insufficiency in RA patients,ERA was more significant.And cardiac function was correlated with age,blood pressure,DAS-28,symptom sign score,laboratory indicators.