类风湿性关节炎患者肺动脉收缩压与疾病活动性的相关性研究  

Correlation study of pulmonary arterial systolic pressure and disease activity in patients with rheumatoid arthritis

作　　者：杨芳[1,2] 岳文胜[1,2] 黄多[1,2] 刘剑平[3,2] 周京国[3,2] 曹礼庭[1,2] 邹媛[1,2] 王亚萍[1,2] 马丽琼[1,2] 

机构地区：[1]川北医学院附属医院超声诊断科 [2]川北医学院医学影像四川省重点实验室,四川省南充市637000 [3]川北医学院附属医院风湿血液科

出　　处：《临床超声医学杂志》2015年第5期301-304,共4页Journal of Clinical Ultrasound in Medicine

基　　金：四川省科技厅应用基础项目(2011JY0140)

摘　　要：目的探讨不伴有心血管疾病临床表现的类风湿性关节炎(RA)患者肺动脉收缩压力(PASP)与RA疾病活动状态的相关性。方法 RA活动期不伴有心血管疾病临床表现患者55例为RA活动期组,体检健康者50例为对照组。应用超声心动图三尖瓣反流法测量PASP,并测量右室舒张末期和收缩末期横径(RVEDd、RVESd),肺动脉内径(PAD),三尖瓣口舒张早期血流最大速度E峰(E)、舒张晚期血流最大速度A峰(A),计算E/A和右室心肌做功指数(RVMPI);测量血沉(ESR)、C-反应蛋白(CRP)、抗环瓜氨酸肽抗体(Anti-CCP)。结果与对照组比较,RA活动期组RVEDd、RVESd、PAD、A、RVMPI及PASP增大,三尖瓣反流者增多,E/A减低,差异均有统计学意义(均P<0.05)。RA活动期组肺动脉高压(PAH)发生率为26%;RA活动期组PASP与CRP、DAS28、Anti-CCP呈正相关(r值分别为0.545、0.472、0.213,P<0.01)。结论 RA活动期患者在出现明显心血管疾病临床表现前已出现PASP增高,RA活动期炎性免疫机制可能促进患者PASP升高,导致患者右室功能整体下降。Objective To investigate the correlation between pulmonary arterial systolic pressure （PASP） and disease activity in rheumatoid arthritis （RA） patients without clinical manifestations of cardiovascular disease.Methods Fifty-five RA patients without clinical manifestations of cardiovascular disease were enrolled as active RA group,50 healthy subjects were included as control group.PASP was determined by measuring the peak systolic pressure gradient from the right ventricle to the right atrium.Meanwhile,right ventricular end-diastolic and end-systolic diameter（RVEDd,RVESd）,pulmonary artery diameter （PAD）,the early diastolic tricuspid valve flow peak velocity（E）,late diastolic tricuspid valve flow peak velocity（A）were respectively measured.The E/A and right ventricular myocardial performance index（RVMPI） were calculated.In addition,laboratory indicators such as blood sedimentation （ESR）,C-reactive protein（CRP） and anti-cyclic citrullinated peptide antibody （Anti-CCP） were also measured.Results Compared with control group,RVEDd,RVESd,PAD,RVMPI,A and the cases of tricuspid regurgitation was significantly higher in active RA group,however,E/A was lower （P＜0.05）.In addition,the PASP was higher in active RA group （P＜0.05）.Furthermore,among these 55 RA patients,14（26％） of them had pulmonary arterial hypertension （PAH）.The PASP were positively correlated with CRP,disease activity scores in twenty-eight-joint （DAS28） and Anti-CCP（r value were 0.545,0.472,0.213,P＜0.01）.Conclusion PASP occurs before clinical manifestations of cardiovascular disease in patients with active RA.It suggests that inflammatory activity and immune mechanisms may promote PASP increase leading to decrease of right ventricular function in RA active patients.

关 键 词：超声心动描记术 类风湿关节炎 肺动脉收缩压 免疫指标 

分 类 号：R540.45[医药卫生—心血管疾病] R593.22[医药卫生—内科学]