强直性脊柱炎伴缺血性脑血管事件患者的危险因素分析

Risk factors for ischemic stroke in ankylosing spondylitis patients

目的探讨强直性脊柱炎是否增加缺血性脑血管事件的风险。方法连续收集本院2004年1月1日-2014年1月1日确诊脑梗死的强直性脊柱炎患者75例作为病例组,同时收集年龄和性别相匹配的受试者150例作为对照组。检测2组吸烟、肥胖、血脂、脂蛋白、尿酸、炎性指标。结果病例组的吸烟比例显著高于对照组（64.0%vs42.7%,P=0.003）;而TG[（1.73±1.58）mmol/L vs（1.80±1.47）mmol/L,P=0.001]、HDL[（1.06±0.50）mmol/L vs（1.23±0.33）mmol/L,P=0.000]、载脂蛋白B[（0.88±0.24）mmol/L vs（1.05±0.26）mmol/L,P=0.000]、载脂蛋白E[（3.87±1.02）mmol/L vs（4.67±2.88）mmol/L,P=0.000]和脂蛋白（a）[（23.87±17.77）mmol/L vs（29.90±10.52）mmol/L,P=0.000]较对照组显著减低,致动脉粥样硬化指数增高（4.35±1.59 vs3.90±1.27,P=0.001）。多因素logistic回归分析显示,吸烟、载脂蛋白B和脂蛋白（a）是强直性脊柱炎伴缺血性脑卒中的独立危险因素。结论强直性脊柱炎患者发生缺血性脑血管病的风险与吸烟、致动脉粥样硬化指数增高相关。对此类患者应于用更积极的控烟和调脂治疗措施,以减少脑血管病的发生。

Objective To study the risk factors for ischemic stroke in ankylosing spondylitis（AS）patients.Methods Seventy-five AS patients with ischemic stroke admitted to our hospital from 2004-01-01 to 2014-01-01 served as an experimental group,and 150age-and sex-matched subjects served as a control group in this study.Their history of smoking and severity of obesity were recorded,and their serum levels of lipid,apolipoproteins,uric acid,and inflammatory indicators were measured.Results The proportion of smokers was significantly higher in experimental group than in control group（64.0% vs 42.7%,P =0.003）.The serum levels of TG [（1.73±1.58）mmol/L vs（1.80±1.47）mmol/L,P=0.001],HDL[（1.06±0.50）mmol/L vs（1.23±0.33）mmol/L,P=0.000],apoB[（0.88±0.24）mmol/L vs（1.05±0.26）mmol/L,P=0.000],apoE[（3.87±1.02）mmol/L vs（4.67±2.88）mmol/L,P=0.000]and Lp（a）[（23.87±17.77）mmol/L vs（29.90±10.52）mmol/L,P=0.000]were significantly lower whereas the atherogenic index was significantly higher in experimental group than in control group（P=0.001）.Logistic analysis showed that smoking,apoB and atherogenicindex were positively associated with ankylosing spondylitis patients with stroke.Conclusion The risk of ischemic stroke is associated with smoking and high atherogenic index in AS patients.Effective measures should be taken for such patients,including control of smoking and antilipid therapy.