早期类风湿关节炎患者外周血管病变和内皮功能的超声研究  

Evaluation of vascular lesion and endothelial function of peripheric arterial in patients with early-stage rheumatoid arthritis by ultrasound

作　　者：张征[1] 郭发金[1] 任俊红[1] 王芳[2] 李超群[1] 王川予[1] 

机构地区：[1]卫生部北京医院超声科,100730 [2]卫生部北京医院风湿免疫科,100730

出　　处：《中国心血管杂志》2013年第2期103-106,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的应用高分辨率超声对早期类风湿关节炎(RA)患者外周动脉形态学、血流动力学及血管内皮功能的改变进行观察。方法检测30例早期RA患者与30例健康对照者肱动脉、足背动脉的变化,并进行统计学分析。结果 (1)RA组肱动脉、足背动脉内中膜厚度(IMT)均处于正常范围,但与对照组相比,RA组足背动脉IMT[(0.40±0.06)mm]明显增厚(P<0.01);肱动脉、足背动脉的舒张早期反向血流峰值流速(PRV)[肱动脉(15.52±2.37)cm/s;足背动脉(16.15±3.24)cm/s]、舒张末期血流速度(EDV)[肱动脉(10.87±2.16)cm/s;足背动脉(11.46±3.17)cm/s]和搏动指数(PI)(肱动脉5.95±1.89;足背动脉7.08±2.27)较对照组均明显减低(均为P<0.05)。(2)RA组肱动脉扩张系数(DC)(13.59±4.25)、血流介导的内径扩张百分比值(FMD)(14.52%±4.91%)较对照组减低,僵硬度(SD)(164.37±58.79)较对照组增高(均为P<0.05),而足背动脉的DC(12.17±3.64)和FMD(12.45%±3.24%)较对照组明显减低,SD(189.28±57.83)较对照组显著增高(均为P<0.01)。(3)Bland-Altman分析法显示重复测量肱动脉、足背动脉内皮功能参数差值与均值呈一致性的变化趋势。结论早期RA患者肢体动脉内皮功能受损,顺应性减低,僵硬度增加,高分辨率超声检查对于诊断RA患者早期动脉粥样硬化具有重要价值。Objective To evaluate the changes of morphology, hemodynamic and endothelial function of peripherie arterial in patients with early-stage rheumatoid arthritis by high-resolution ultrasound. Methods A total of 30 patients with early-stage rheumatoid arthritis and 30 healthy persons were enrolled in this study. The morphology, hemodynamic and endothelial function of brachial artery and dorsal artery of the foot were measured. Results （ 1 ） Compared with control groups, the intima-medial thickness （IMT） of dorsal artery of the foot （ 0.40 ± 0. 06 ） was thickened significantly, and the peak reverse velocity （ PRV ） （brachial artery 15.52 ±2. 37; dorsalis pedis artery 16. 15 ±3.24） in early diastole, the velocity in end diastole （EDV） （brachial artery 10. 87± 2. 16; dorsalis pedis artery 11.46 ±3.17） and pulsatility index （PI） （brachial artery 5.95± 1.89; dorsalis pedis artery 7.08 ±2. 27 ） were reduced significantly in rheumatoid groups（ all P 〈 0. 05 ）. （2）The changes of distensibility coefficient （DC） （13.59± 4. 25 ）, and flow-mediated dilatation （FMD） （14. 52±4. 91 ）of brachial artery with rheumatoid were reduced while the stiffness degree （SD） （ 164. 37 ±58.79） were increased compared with control groups（all P 〈0. 05）. And the changes of dorsal artery of the foot （ DC 12. 17 ±3.64 ; FMD 12. 45 ± 3.24 ; SD 189. 28 ±57.83） had a significant difference （ all P 〈 0. 01 ）. （ 3 ） Bland-Altman analysis showed the variability of endothelial function parameters was very little. Conclusions The endothelial function of peripheric arterial is impaired, the compliance is reduced and the stiffness is increased in patients with early-stage rheumatoid arthritis. High- resolution uhrasonography for diagnosis of early atherosclerosis in patients with RA is of great value.

关 键 词：类风湿关节炎 内皮功能 超声检查 

分 类 号：R593.22[医药卫生—内科学] R445.1[医药卫生—临床医学]