超敏C反应蛋白作为炎症因素增加银屑病关节炎心血管发病风险：一项横截面病例对照研究  

Inflammatory burden interacts with conventional cardiovascular risk factors m patients with psoriatic arthritis： a cross-sectional study

作　　者：于水莲[1] 黄闰月[3] 王羿升[2] 黄文辉[1] 黄成辉[1] 刘明岭[4] 陶怡[1] 

机构地区：[1]广州医科大学附属第二医院风湿免疫科,510260 [2]广州医科大学附属第二医院统计学教研室,510260 [3]广东省中医院风湿免疫科 [4]广州中医药大学附属第一医院风湿免疫科

出　　处：《中华风湿病学杂志》2016年第9期585-591,共7页Chinese Journal of Rheumatology

基　　金：国家自然利学基金（81300585）;教育部博士点新教师项目（20134423120002）

摘　　要：目的探讨全身炎症因素与银屑病关节炎（PsA），高心血管疾病（CVD）发病相关性。方法横截面病例对照研究纳入PsA患者40例及对照组44例，对2组CVD危险因素进行比较，并通过回归分析进一步矫正BMI与hs-CRP评估全身炎症因素对PsA高CVD的影响。采用χ^2俭验、t检验，偏态分布比较用Marm-Whitney U检验,相关分析用Spearman相关分析，多因素分析采用Logistic逐步回归分析及多因素线性回归分析。结果作为已知混杂因素，PsA组患者BMI显著高于对照组，经BMI矫正后PsA组患者合并高血压风险是对照组的5．615倍（OR=5．615，95％CI．1844-17．099）、合并糖尿病风险是对照组的10．655倍（OR=10．655，95％CI1．150-98．683）；与对照组相比，合并高血压的PsA患者收缩压、缩张压均明显高，而合并糖尿病的PsA患者血糖明显升高；PsA患者血清HDL明显降低、TC／HDL升高、全身炎症反应相关指标如白细胞、血小板、hs—CRP显著高于对照组。而作为未知混杂因素，PsA患者hs-CRP水平亦显著高于对照组[4．0（2．1～13．9）与1．7（1．3-2.2）]，并与CVD危险因素如BMI、腰围、收缩压、血糖、血肌酐均呈正相关、HDL呈负相关，与全身炎症反应相关指标如血小板、白细胞亦呈正相关；经hs-CRP进一步矫正后PsA合并高血压风险仍为对照组的3．544倍（OR=3．544．95％CI 1．151～10．914），合并糖尿病风险差异无统计学意义；与对照组相比．合并高血压的PsA患者收缩压显著升高，而其中PsA血清TG水平、全身炎症反应相关指标如白细胞、血小板仍显著高于对照组。结论早期积极控制炎症反应将有效降低PSA的CVD发病风险，其致病原因有可能与炎症信号转导通路之间存在着复杂的交汇作用有关。Objective To examine the distribution of systemic： inflammation and risk factors of cardiovascular disease （CVD） in patients with psoriatic arthritis （PsA） by companng with healthy controls. Methods Forty PsA patients and 44 controls were reeruited into this cross-sectional study. We evaluated the disease activity and severity [erythrocyte sedimentation rate （ESR）, C reactive prolein（CRP） and Disease Ac, tivity Score （DAS）28], functional ability in patients with predominant axial involement [Bath AS disease activity index （BASDAI） and Bath AS functional index （BASFI）], lraditional CVD risk fatctors and inflammation between these two groups of patients. Then, we compared risk factors for CVD between 40 consecutive PsA patients and 44 controls, adjusted for body mass index （BMI）. The frequencies were compared using chi-square tests for categorical variables. Student＇s t-tests or Mann-Whitney U-tests were used forcontinuous variables where appropriate. Association between the traditionaland metabolic risk faetors and the hs-CRP level were assessed using Spearman correlations. Finally, we also assessed the role of inflammation on the CVD risk factor by using a BMI and hs-CRP-adjusted model. Results The BMI of PsA patients was significantly higher than that of the controls. After adjusting for the BMI, PsA patients had a higher prevalence of hypertension （OR= 5.615, 95%CI 1.844-17.099） and diabetes mellitus （OR=10.655, 95%CI 1.150-98.683） than the controls. PsA patients had significantly increased systolic and diastolic blood pressures [（SBP） and （DBP）], total cholesterol （TC）Paigh density lipoprotein cholesterol （HDL）, insulin resistance, inflammatory markers （hsCRP, white cell count and platelet） and decreased HDL compared to the controls. As excepted, the hsCRP level [4.0 （2.1-13.9） vs 1.7 （1.3-2.2）] , platelet and white cell counts were significantly increased in the PsA group reflecting underlying inflammation. Further adjustment for hsCRP le

关 键 词：关节炎 牛皮癣 心血管疾病 C反应蛋白质 

分 类 号：R758.63[医药卫生—皮肤病学与性病学] R54[医药卫生—临床医学]