类风湿关节炎患者发生动脉硬化的影响因素分析

Incidence Rate of Arteriosclerosis in Patients with Rheumatoid Arthritis

目的采用高分辨率超声测定类风湿关节炎(rheumatoid arthritis,RA)患者颈动脉内中膜厚度和是否有斑块以及是否存在动脉硬化。方法分析2009年4月—2010年9月间150例RA患者的一般情况、发病情况、疾病活动性评分(DAS28评分),及实验室指标如:血沉(ESR)、C反应蛋白(CRP)、抗环瓜氨酸抗体(ACCP)、类风湿因子(RF)、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白a及血尿酸的测定。采用颈动脉彩色多普勒超声测定RA患者与正常对照组120例颈动脉内中膜值及是否有斑块。结果 150例RA患者20例出现动脉硬化,120例健康人群中3例出现动脉硬化,RA颈动脉内硬化危险因素单因素分析中,病程、DAS28评分、ApoA1、ApoB、HDL-C及尿酸与RA动脉硬化有关,而年龄、性别、ESR、CRP、RF、ACCP等与RA发生动脉硬化无关;RA动脉硬化多因素回归分析示:病程、尿酸及高密度脂蛋白是RA发生动脉硬化的危险因素。结论颈动脉内中膜测定对RA动脉硬化具有一定临床价值。

Objective To detect the carotid artery intima-media thickness and the existence of carotid plague and arteriosclerosis by high-resolution ultrasonography in patients with rheumatoid arthritis（RA）.Methods A total of 150 RA patients treated in our hospital between April 2009 and September 2010 were included in this study.Their general condition,onset of the disease and disease activity score（DAS28 scoring） were analyzed.Laboratory indexes like erythrocyte sedimentation rate（ESR）,C reactive protein（CRP）,Anti-cyclic citrullinated peptide（ACCP） antibody,rheumatoid factor（RF）,total cholesterol（TC）,triglycerides（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,apolipoprotein A1（apo A1）,apolipoprotein B（apo B）,lipoprotein（a）（Lp（a））,and uric acid（UA） were measured.Carotid color ultrasonography was used to detect the carotid intima-media thickness and the existence of carotid plague in 150 patients with RA and 120 patients in the control group.Results Twenty out of the 150 RA patients and three out of the 120 controls manifested arteriosclerosis.Single factor analysis showed a correlation between arteriosclerosis in RA patients and course of disease,DAS28 scoring,Apo A,Apo B,HDL-C,and UA,and no correlation between arteriosclerosis and age,gender,ESR,CRP,RF,and ACCP.Multivariate regression analysis showed that the course of disease,UA and HDL-C are independent risk factors for arteriosclerosis in RA patients.Conclusion Analysis of the carotid intima-media has a certain clinical value in predicting arteriosclerosis in RA patients.