缺乏心血管疾病临床表现的类风湿关节炎患者颈动脉弹性功能的研究

Assessment of carotid arterial elasticity in active rheumatoid arthritis patients without clinical manifestations of cardiovascular disease

目的探讨缺乏心血管疾病临床表现的类风湿关节炎(RA)活动期患者颈动脉血管内膜-中层厚度(intima-media thickness,IMT)和弹性功能的改变。方法纳入川北医学院附属医院风湿血液科检查并证实RA住院活动期患者45例,并选取本院体检中心年龄、性别匹配的健康对照者45例;所有受检者均行双侧颈动脉的超声检查,测量颈动脉IMT,并采用E-tracking(ET)技术测量颈总动脉弹性指标,主要包括血管僵硬系数(β)、压力应变弹性系数(Ep)、动脉顺应性(AC)、增大指数(AI)和脉搏波传播速度(PWVβ)。结果 RA组颈动脉平均IMT处于正常范围,但高于对照组分别为(0.73±0.14)与(0.59±0.09)mm,P<0.01;RA组双侧颈总动脉β、Ep、PWVβ均较健康对照组增高,右侧分别为(8.2±2.7)与(6.1±3.0),P=0.003;(111±43)与(80±43)kPa,P=0.002和(6.3±1.2)与(5.4±1.2)m/s,P=0.001;左侧分别为(8.1±2.8)与(6.3±2.3),P=0.003;(110±42)与(83±34)kPa,P=0.003和(6.3±1.2)与(5.6±1.1)m/s,P=0.005。RA组右侧颈总动脉AC值低于对照组(0.8±0.4)mm/KPa与(1.0±0.4)mm/kPa,P=0.012,AI值2组之间差异无统计学意义,右侧分别为(15±12)%与(15±9)%,P=0.83;左侧分别为(14±8)%与(13±11)%,P=0.69。结论缺乏心血管疾病临床表现的RA活动期患者IMT逐渐开始增厚,血管弹性功能下降,动脉血管硬化进程明显早于健康人群。

Objective To assess the change of carotid intima media thickness（IMT） and arterial elasticity in ac- tive rheumatoid arthritis patients without clinical manifestations of cardiovascular disease. Methods Consecutive 45 active RA inpatients without clinical manifestations of cardiovascular disease and 45 age- and sex-matched healthy subjects were enrolled. The IMT of carotid arteries were assessed by ultrasonography in all subjects. The indexes of common carotid artery elasticity included 13 （stiffness parameter）, Ep（pressure -strain elasticity modulus）, AC（arterial compliance）,AI（augmentation index）, PWVI3（pulse wave velocity） were measured by echo tracking technique（ET）. Resuits The IMT of carotid arteries in patient with RA was higher than control group（P〈0.01） . β、Ep、PWVβ were also higher in patient with RA than in healthy subjects （P〈0.05）, while AC was lower in patient with RA （P〈0.05）. Conclusion IMT gradually began to thickening and blood vessel elasticity function decreased in active rheumatoid arthritis patients without clinical manifestations of cardiovascular disease. The process of arterial sclerosis was significantly earlier than normal healthy people.