类风湿关节炎患者早发动脉粥样硬化的脂代谢紊乱与内皮细胞功能异常初步探讨  

Preliminary study of lipid metabolism disorders and endothelial cell dysfunction about early onset atherosclerosis in patients with rheumatoid arthritis

作　　者：王志会[1] 王雪燕[2] 韩嫣[3] 孙熠峰[1] 张明峰[1] 刘淑霞[4] 

机构地区：[1]河北医科大学第二医院免疫风湿科,河北石家庄050000 [2]承德医学院附属医院血液风湿科,河北承德067000 [3]河北医科大学 [4]河北医科大学病理学教研室,河北石家庄050017

出　　处：《临床荟萃》2013年第6期610-612,616,共4页Clinical Focus

基　　金：河北省卫生厅医学科学研究重点课题(20100327)

摘　　要：目的初步探讨脂质代谢紊乱及内皮功能异常在类风湿关节炎(RA)患者早发动脉粥样硬化中的作用。方法收集河北医科大学第二医院2009～2010年门诊和住院RA患者69例,与之匹配正常对照组(对照组)27例。检测患者血脂水平;超声检测颈总动脉内膜中层厚度(IMT)和颈动脉粥样斑块数目;采用流式细胞术检测单核细胞中CD14+CD106+的表达。结果①RA患者甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平高于对照组,(0.99±0.23)mmol/L vs(0.86±0.31)mmol/L,(2.33±0.58)mmol/L vs(2.01±0.62)mmol/L(P<0.05),高密度脂蛋白胆固醇(HDL-C)、apoA1/apoB比值水平低于对照组,(1.52±0.27)mmol/L vs(1.68±0.37)mmol/L,1.28±0.51vs 1.79±0.66(P<0.01或<0.05);②有颈动脉粥样斑块的RA患者总胆固醇(TC)、TG、LDL-C水平高于无颈动脉粥样斑块者,(4.21±1.26)mmol/L vs(3.09±1.13)mmol/L,(1.06±0.28)mmol/L vs(0.82±0.17)mmol/L,(2.44±0.73)mmol/L vs(1.72±0.49)mmol/L(P<0.01或<0.05),而apoA1/apoB比值水平显著减低,1.69±0.46vs 2.03±0.32(P<0.05);③RA患者的IMT高于对照组,(0.71±0.56)mm vs(0.44±0.36)mm(P<0.05);IMT与RA患者的病程、TG、LDL-C水平呈正相关(rs=0.346、0.441、0.368;P<0.05或<0.01),与apoA/apoB比值呈负相关(rs=-0.487,P<0.05),④RA组患者的CD14+CD106+细胞水平显著高于健康对照组(77.05±8.07)%vs(52.17±9.90)%(P<0.01),并CD14+CD106+细胞与IMT呈正相关(rs=0.356,P<0.05)。结论 RA患者的严重脂质代谢紊乱与内皮细胞功能异常与早发动脉粥样硬化密切相关。Objective To investigate the effects of lipid metabolism disorders and endothelial cell dysfunction about early onset atherosclerosis in patients with rheumatoid arthritis（RA）. Methods Blood lipid levels,intimal medial thickness（IMT） of common carotid artery and atheromatous plaque were measured bY auto-biochemical analyzer and diasonograph respectively in 69 patients with RA（RA group） and 27 healthy subjects（control group） in matches during 2009-2010 from the the Second Hospital of Hebei Medical University. The CD14＋ CD106^＋cells in blood samples were detected by flow cytometry. Results ①The lipid levels of triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） in RA group were significantly higher than those of control group, （0.99± 0.23） mmol/L vs （0.86± 0.31） mmol/L, （2.33±0.58） mmol/L vs （2.01 ±0.62） mmol/L （ P〈0.01 or 〈0.05）, while high density lipoprotein eholesterol（HDL-C） ,apoA1/apoB levels dropped significantly, （1.52±0. 27） mmol/L vs （1.68±0.37） mmol/L,1.28±0.51 vs 1.79±0.66（ P 〈0.01 or 〈0.05）. ②Compared with RA patients who had atheromatous plaque,the levels of total cholesterol（TC）, TG, LDL-C were significantly higher than those without atheromatous plaque, （4.21± 1.26 ） mmol/Lvs （3.09±1.13） mmol/L, （1. 06±0. 28） mmol/L vs （0.82±0.17） mmol/L,（2.44±0.73） mmol/L vs （1.72±0.49） mmol/L（ P 〈0.01 or 〈0.05）. But the ratio of apoA1/apoB was significantly lower, 1.69± 0.46 vs 2.03±0.32（ P 〈0.05）. ③The IMT of patients with RA was higher than that of control group,（0.71±0.56） mm vs （0.44±0.36） mm（ P 〈0.05）. The IMT showed positive correlation with RA course,TG and LDL-C（ rs =0. 346, 0. 441,0. 368, P %0.05 or 〈0.01）, while it had negative correlation with the ratio of apoA1/apoB（ rs=-0. 487, P〈0.05）. ④The percentage of CD14＋ CD106＋ cells in RA patients was significantly higher than that of healthy control group,（77.05±8.07）% vs �

关 键 词：关节炎 类风湿 动脉粥样硬化 颈动脉 抗原 CD31 超声检查 

分 类 号：R593.2[医药卫生—内科学]