抗风湿药物对类风湿关节炎患者心血管疾病的预防作用及机制

Effects and Mechanism of Atherosclerosis Prevention by DMARDs in Patients with Rheumatoid Arthritis

目的探讨抗风湿药物(DMARDs)治疗类风湿关节炎(RA)患者早发性动脉硬化的效果和机制,为减少RA患者心血管意外的发生提供理论依据。方法对72例早期RA患者,分别在治疗前后检测红细胞沉降速率(ESR)和超敏C-反应蛋白(hs-CRP)以评价患者炎症情况,并监测颈动脉内-中膜厚度(cIMT)以及内皮依赖性血管舒张功能(ED-FMD)。在研究过程中使用疾病程度指数评级标准(DAS28)评估RA疾病严重程度,使用健康评估问卷-伤残指数(HAQ-DI)评级标准评定患者的生活质量。根据患者疾病严重程度应用甲氨蝶呤(MTX)、羟氯喹(HCQ)和柳氮磺吡啶(SSZ)3种药物单独或者联合治疗。结果治疗1年后,ESR、hs-CRP、DAS28与HAQ-DI均有显著改善(均P<0.01),同时患者的血脂状况也有明显变化。体质量指数(BMI)的差异无统计学意义(P=0.58)。治疗1年后cIMT值(0.43±0.08)mm比基础水平(0.50±0.16)mm显著下降(P=0.002)。FMD%由基础水平5.26升高至7.57,差异有统计学意义(P=0.041)。结论使用DMARDs对RA进行早期干预不仅能有效控制病情,而且可以延缓动脉粥样硬化的进程,还可以降低心血管事件引起的病死率。

Objective To investigate the effect of DMARDs on the prevention of early-onset atherosclerosis in rheumatoid arthritis （ RA） patients for exploring an appropriate schedule to reduce cardiovascular events. Methods Seventy-two patients with early RA were included in this study. Erythrocyte sedimentation rate （ ESR） and high sensitivity C reactive protein （ hs-CRP） were detected before and after treatment to evaluate inflammation. Carotid intima-media thickness （ cIMT） and endothelium-dependent flow-mediated vasodilatation （ED-FMD） were monitored. Disease Activity Score in 28 Joints （DAS28） and health assessment questionnaire-disability index （ HAQ-DI） was used to assess severity degree of RA and life quality of the patients, respectively. The patients were treated with methotrexate （MTX）, hydroxychloroquine （HCQ） and sulfasalazine （SSZ） alone or combined based on severity of RA. Results After 1 year of treatment, ESR, hs-CRP, DAS28 and HAQ-DI were significantly improved （all P〈0. 01）. At the same time, the serum lipid levels also had obvious changes. However, there was no obvious difference in body mass index （ BMI） after 1 year. The cIMT ratio value was significantly decreased compared to baseline （0. 43±0. 08 mm vs. 0. 50±0. 16 mm, P=0. 002）, and FMD% also significantly improved from basic value of 5. 26 to 7. 57 after treatment （P=0. 041）. Conclusion Early intervention of RA by using DMARDs can effectively control the disease and slow the progression of atherosclerosis, but also reduce cardiovascular mortality.