类风湿关节炎合并冠心病患者的临床特点及预后分析

Clinical characteristics and prognosis analysis in patients with rheumatoid arthritis complicated by coronary heart disease

目的探讨类风湿性关节炎(RA)合并冠状动脉粥样硬化性心脏病(冠心病)患者的冠状动脉(冠脉)病变特点及介入治疗后的长期预后。方法连续入选2010年1月至2017年12月于郑州大学附属洛阳市中心医院收治的RA合并冠心病的患者70例作为RA合并冠心病组,同时选取与其年龄和性别匹配的冠心病患者140例作为冠心病组,均行冠脉造影检查。对两组的临床特点、冠脉病变特点及冠脉介入治疗后的长期预后情况进行分析。结果RA并冠心病组的体质指数、总胆固醇水平明显低于冠心病组(P均<0.05)。冠脉造影结果中,RA合并冠心病组患者,GENSINI评分明显比冠心病组高(P<0.05)。在长期随访中发现,RA并冠心病组患者的全因死亡率(5.9%vs.1.5%,P<0.05)、心血管相关死亡率(2.9%vs.0.7%,P<0.05)、因ACS再次住院率(35.3%vs.18.5%,P<0.05)、因急性心肌梗死再次住院率(7.4%vs.4.4%,P<0.05)均明显高于单纯冠心病组,再次血运重建率基本持平。结论传统危险因素在RA患者动脉粥样硬化的发生中发挥了重要作用,但RA的病程也是导致动脉粥样硬化发生的独立危险因素。且RA合并冠心病患者的冠脉血管病变范围及程度更重。RA并冠心病的预后较差。其再次血运重建率与冠心病患者基本持平,或许提示了目前RA相关的心血管治疗的不足。

Objective To discuss the coronary lesion characteristics and long-term prognosis in patients with rheumatoid arthritis complicated by coronary heart disease(RA-CHD)after interventional treatment.Methods The patients with RA-CHD(n=70)were continuously chosen(RA-CHD group)from Central Hospital of Luoyang City affiliated to Zhengzhou University from Jan.2010 to Dec.2017.At the same time,the patients with CHD(n=140,matched in age and sex)were chosen(CHD group).All patients were given examination of coronary angiography(CAG).The clinical characteristics,coronary lesion characteristics and long-term prognosis after interventional treatment were analyzed in 2 groups.Results The levels of body mass index(BMI)and total cholesterol(TC)were significantly lower in RA-CHD group than those in CHD group(all P<0.05).The results of CAG showed that GENSINI scores were significantly higher in RA-CHD group than those in CHD group(P<0.05).The results of long-term follow-up showed that all-cause mortality(5.9% vs.1.5%,P<0.05),cardiovascular-related mortality(2.9% vs.0.7%,P<0.05),re-hospitalization rate due to acute coronary syndrome(35.3% vs.18.5%,P<0.05),and re-hospitalization rate due to acute myocardial infarction(7.4%vs.4.4%,P<0.05)were significantly higher in RA-CHD group than those in CHD group,and re-revascularization rate were basically the same in 2 groups.Conclusion Traditional risk factors play a very important role in occurrence of atherosclerosis in RA patients,and RA course is an independent risk factor of CHD.The range of coronary lesions will be larger and severity will be severer in patients with.The prognosis of RACHD is poor.The re-revascularization rate were basically the same in patients with RA-CHD and in those with only CHD,which may indicate the shortages in treatment of RA-related cardiovascular diseases.