心血管标志物及血清炎性因子与类风湿关节炎中高血压发病相关性研究

Correlation between cardiovascular markers and serum inflammatory factors associated with hypertension in rheumatoid arthritis

目的探讨心血管标志物、血清炎性因子在类风湿关节炎(RA)伴发高血压发病的相关性和可能原因。方法检测红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、白细胞介素-17(IL-17)、IL-22、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-3(MMP-3)、血清同型半胱氨酸、疾病活动性评分系统(DAS28)、瘦素水平和胰岛素抵抗力[内环境稳态评价指数(HOMA)],比较上述指标在试验组(RA伴发高血压组)和对照组(RA不伴发高血压组)中差异。结果试验组患者平均病程长及发病年龄均高于对照组(P<0.05)。血清同型半胱氨酸水平在试验组[12.1(6.5,14.5)μmol/L]较对照组[8.1(6.8,10.9)μmol/L]显著增高,2组比较差异有统计学意义(P<0.01)。通过比较性别、年龄、吸烟情况、体质量指数(BMI)、糖皮质激素、改善病情抗风湿药(DMARDs)及非甾体类抗炎药物(NSAIDs)使用情况后,结果提示血清MMP-3水平[OR 95%CI:1.8(0.9,4.3),P=0.042],血清同型半胱氨酸水平[OR 95%CI:2.8(1.6,5.6),P=0.001)]及瘦素水平[OR 95%CI:2.2(1.1,3.9),P=0.039]在RA伴发高血压组中明显增高。ESR、hs-CRP、IL-17、IL-22、TNF-α、HOMA及DAS28评分在2组间比较,差异无统计学意义(P>0.05)。结论 RA伴发高血压的发生与全身炎性因素和胰岛素抵抗无直接相关性,与血清中MMP-3、同型半胱氨酸和瘦素水平增高有关,与肥胖和血管内平衡功能紊乱相关。

Objective To investigate the correlation and possible causes of cardiovascular markers and serum inflammatory factors associated with hypertension in rheumatoid arthritis （RA）. Methods Erythrocyte sedimentation rate （ESR）, high-sensitiviU C-reactive protein （hs-CRP）, interleukin-17 （IL-17）, interleukin-22 （IL-22）, tumor necrosis factor-α （TNF）, matrix metalloproteinase-3 （MMP-3）, serum homocysteine, disease activity scoring system （DAS28）, leptin levels, and insulin resistance [homeostasis model assessment index （HOMA）] were measured and compared between a group of RA and hypertension patients and a control group iRA patients without hypertension）. Results The mean duration of disease and the age of onset in RA patients with hypertension were higher than those in the control group （P〈0.05）. Serum homocysteine levels were significantly higher in patients with concomitant RA and hypertension [ 12.1 （6.5,14.5） μmol/L] than in the control group [ 8.1 （6.8,10.9） μmol/L], with statistically significant difference （P〈0.01）. After adjusting for gender, age, smoking status, body mass index （BMI）, medica- tions with glucocorticoids, disease-modifying antirheumatic drugs （DMARDs） and non-steroidal anti-inflammatory drugs （NSAIDs）, serum MMP-3 levels [OR 95% CI：1.8 0.9,4.3）,P=0.042 ], serum homocysteine levels [OR 95% CI：2.8 （1.6,5.6）,P=0.001 ）]and leptin levels [OR 95% CI：2.2 （l.1,3.9）,P=0.039 ] were significantly higher in the group with concomitant RA and hypertension. There was no significant differences in ESR,hsCRP,IL-17,IL-22, TNF- α, HOMA and DAS28 scores between the two groups Call P〉0.05）. Conclusion The occurrence of hypertension in RA is not directly con＇elated with systemic inflammatory factors and insulin resistance, but may be correlated with el- evated serum levels of MMP-3, homocysteine, and leptin, and also with obesity and dysfunctions of intravascular bal-ance.