多关节型幼年特发性关节炎活动期血管内皮功能研究

Investigation of vascular endothelial function in active polyarticular juvenile idiopathic arthritis

目的研究多关节型幼年特发性关节炎(JIA)活动期血管内皮功能变化,氧化应激水平及血脂代谢等相关因素的影响。方法将2015年1月至2017年12月华中科技大学同济医学院附属武汉儿童医院住院的多关节型JIA活动期患儿42例分为类风湿因子(RF)阳性及RF阴性组,同期23名健康儿童作为对照组,检测各组肱动脉血流介导的扩张反应(FMD)和颈动脉内中膜厚度(cIMT)、血脂、氧化应激水平并进行比较分析。结果 3组肱动脉FMD均明显下降,RF阳性组下降更明显,差异有统计学意义(P<0.05),c IMT比较差异无统计学意义(P>0.05)。RF阳性组与对照组比较,血清三酰甘油(TG)水平明显升高,高密度脂蛋白胆固醇(HDL-C)水平明显下降,差异均有统计学意义(P均<0.05),血清8-异前列腺素F2a(8-iso-PGF2α)明显升高,差异有统计学意义(P<0.001)。RF阴性组与对照组比较,血脂水平差异无统计学意义(P>0.05)。血清8-iso-PGF2α明显升高,差异有统计学意义(P<0.01)。RF阳性组与RF阴性组比较,血清8-iso-PGF2α升高更明显,差异有统计学意义(P<0.05)。多关节型JIA肱动脉FMD与血清8-iso-PGF2α呈负相关(r=-0.54,P<0.01)。结论多关节型JIA活动期存在血管内皮功能障碍,RF阳性者更明显,其可能与氧化应激水平升高有关,尚不能确定与血脂紊乱有关。

Objective To investigate the changes of vascular endothelial function in children with active polyarticular juvenile idiopathic arthritis(JIA)and the effects of oxidative stress and lipid metabolism on endothelial function.Methods Totally 42 children with active polyarticular JIA were divided into rheumatoid factor(RF)positive group and RF negative group,and 23 healthy children were randomly selected as normal control group. Brachial artery flow-mediated dilation(FMD),carotid intima-media thickness(cIMT),lipid profile and oxidative stress were measured and compared among these groups. Results Brachial artery FMD in the RF positive and the RF negative groups were significantly lower than those in the control group,especially in RF positive patients(P<0.05,respectively). There were no significant differences in c IMT.Serum TG level was significantly higher(P<0.05),while HDL-C level was significantly lower(P<0.05)in the RF-positive group compared with the control group. Serum 8-iso-PGF2α level was significantly higher(P<0.001)in the RF-positive group compared with the control group. However,significant increase in 8-iso-PGF2α level was observed in the RF negative group(P<0.01). Similarly,8-iso-PGF2α level increased more significantly in RF positive group compared with RF negative group(P<0.05). Brachial artery FMD in polyarticular JIA was negatively associated with serum 8-iso-PGF2α(r=-0.54,P<0.01). Conclusion Vascular endothelial dysfunction exists in the active polyarticular JIA,especially in RF-positive patients. Increasing oxidative stress may impair the endothelial function;however,the impact of dyslipidemia on endothelial function is not clear in polyarticular JIA.