血清人类白细胞分化抗原36水平对类风湿关节炎患者心血管风险预测价值的研究

The predictive value of serum human leukocyte differentiation antigen 36 levels in cardiovascular risk in patients with rheumatoid arthritis

目的:探讨血清CD36水平在RA患者心血管风险中的表达及预测价值,为临床识别及预测RA患者中的中、高心血管风险患者提供新的理论依据。方法:选取甘肃省兰州大学第二医院风湿免疫科住院治疗的84例RA患者作为研究对象,健康体检者34名作为对照。所有纳入对象根据中国动脉粥样硬化性心血管疾病风险预测研究(China-PAR)分为低心血管风险组和中高心血管风险组,同时于入院时接受血清CD36水平及其他血清学指标检测,且病例资料完整。应用SPSS 26.0软件进行资料的统计分析,计量资料比较采用 t检验或非参数检验,分类资料比较采用 χ^(2)检验或Fisher精确检验,单因素分析中 P<0.05的变量进入Logistic多因素回归模型。 结果:与健康对照组比较,RA患者的中高心血管风险人数明显增多[8例(23.5%)与38例(45.2%), χ^(2)=4.80, P=0.029],并和血清CD36呈负相关( r=-0.27, P<0.05)。Logistic多因素回归分析结果显示,年龄[ OR值(95% CI)=1.654(1.157,2.365), P=0.029]、舒张压[ OR值(95% CI)=1.225(1.040,1.442), P=0.015]可能是RA患者的中高心血管风险的独立危险因素,血清CD36水平[ OR值(95% CI)=0.569(0.352,0.922), P=0.022]升高可能是RA患者的中高心血管风险的保护因素。绘制受试者工作特征曲线,血清CD36水平诊断RA患者的中高心血管风险的曲线下面积=0.691,截断值为4.27 pg/ml,灵敏度和特异度分别为89.7%、41.0%,具有一定的预测价值。 结论:血清CD36水平在RA患者中随着心血管风险增高而降低,提示血清CD36水平升高是RA心血管风险的保护因素,且血清CD36水平对RA患者心血管风险具有一定的预测价值,是潜在预测指标。

Objective To explore the expression and predictive value of serum CD36 level in cardio-vascular risk in patients with rheumatoid arthritis(RA)and to provide a new theoretical basis for clinical iden-tification and prediction of patients at moderate and high cardiovascular risk in RA patients.Methods Eighty-four RA patients hospitalized to the Department of Rheumatology and Immunology of the second hospital of Lanzhou University in Gansu Province were selected as the study subjects,and 34 healthy people were selected as the controls.All RA patients were divided into low cardiovascular risk groups and medium and high cardiovascular risk groups according to prediction for ASCVD risk in China(China-PAR)cardiovascular risk assessment.At the same time,they were tested for serological indicators at admission.Statistical Product and Service Solutions(SPSS))26.0 software was used for the statistical data analysis.T-test and nonparametric test were used for comparison of the measurement data.The Chi-square test and Fisher's exact test were used for the comparison of classified data.Variables with P<0.05 in univariate analysis were included into the Logistic regression model.Results Compared with the healthy control group,the number of patients with medium and high cardiovascular risk in RA[8 cases(23.5)%and 38 cases(45.2)%,χ^(2)=4.80,P=0.029]was significantly higher and was negatively correlated with serum CD36(r=-0.27,P<0.05).Logistic regression analysis showed that age[OR(95%CI)=1.654(1.157,2.365),P=0.006]and diastolic blood pressure[OR(95%CI)=1.225(1.040,1.442),P=0.015]were independent risk factors for medium and high cardiovascular risk in RA patients,and serum CD36 level[OR(95%CI)=0.569(0.352,0.922),P=0.022]was the protective factor of medium and high cardiovascular risk in RA patients according to the results of Logistic regression analysis.The area under the receiver operating characteristic(ROC)area under the curve(AUC)was 0.691,the cut-off value was 4.27 pg/ml,and the sensitivity and specificity were 89.7%and 41.0%respectively.Conclusion The serum CD36 level decreases with the increase of cardiovascular risk in RA patients.A higher serum CD36 level is a protective factor of cardiovascular risk in RA patients,and CD36 has a certain predictive value for cardiovascular risk in RA patients and is a potential predictor.