炎症因素与早期类风湿关节炎心血管病变相关性研究  

The correlation between inflammatory burden with cardiovascular diseases in patients with early rheumatoid arthritis

作　　者：于水莲[1] 陶怡[1] 王羿升[2] 黄闰月[3] 刘明岭[4] 黄成辉[1] 黄文辉[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11期739-745,共7页Chinese Journal of Rheumatology

基　　金：国家自然科学基金（81300585）;教育部博士点新教师项目（20134423120002）;广东省科技计划项目（2011803231800327）

摘　　要：目的探讨全身炎症因素与早期类风湿关节炎（ERA）高心血管（CVD）发病相关性。方法横截面病例对照研究纳入ERA患者80例及对照组44例，对2组间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ERA高CVD的影响。其中计数资料采用，检验，正态分布计量资料间比较用独立样本t检验，偏态分布计量资料组间比较用非参数检验的MannWhitneyU检验；其次，运用Spearman进行hs-CRP与传统心血管危险因素及代谢因素的秩相关分析；最后，作为混杂因素，进行BMI及hs-CRP矫正后的组间二项分类Losistic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，ERA组患者BMI显著高于对照组，经BMI矫正后ERA组患者合并代谢综合征风险是对照组的8．468倍（OR=8．468，95％CI1．058～67．787）；与对照组相比，合并高血压的患者收缩压120（107．5～132．5）mmHg与133（115．8～147．8）mmHg[OR=1．729，95％CI0．517～2．941]、舒张压均明显升高（72±9）mmHg与（82±12）mmHg[OR=2．902，95％CI1．144～3.414]、血清HDL降低1．7（1．4～2．1）mmol／L与1.4（1．2～1．6）mmol／L[OR=-1．829，95％CI-2．550～1．011]、TC／HDL升高1．7（1．6～1．9）mmol／L与3．2（2．7～4．0）mmol／L[OR=0．299，95％CI-0．453～1．052]、同时ERA患者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，ERA患者hs-CRP水平亦显著高于对照组，并与CVD危险因素如BMI、收缩压、舒张压均呈正相关、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ERA组患者合并代谢综合征风险仍为对照组的6．493倍（OR=6．493，95％CI1．028～67．123），其中合并高脂血症的ERA患者血清HDL仍显著降低，ERA患者全身炎症反应相关指标如白细胞、血小板仍显著高Objective To examine the distribution of traditional and inflammation of cardiovascular disease （CVD） in patients with early rheumatoid arthritis （ERA）. Methods We compared risk factors for CVD between 80 consecutive EAR patients and 44 controls, adjusting for body mass index （BMI）. We also assessed the role of inflammation on the CVD risk factor by using a BMI and high-sensitivity CRP （hsCRP）-adjusted model. The frequencies were compared using chi-squared tests for categorical variables. Student＇s t-tests or Mann-Whitney U-tests were used for continuous variables where appropriate. Association between the traditi.onal and metabolic risk factors and the hs-CRP level were assessed using Spearman＇s correlations.Finally, we also assessed the role of inflammation on the CVD risk factor by using a BMI and hsCRP-adjusted model. Results The BMI of RA patients were significantly higher than healthy controls. After adjusted for the BMI, ERA patients had a higher prevalence of metabolism syndrome （OR =8.468, 95% CI 1.058-67.787） compared to the controls. RA patients had significantly increased systolic and diastolic blood pressures {SBP 120（107.5-132.5） mmHg vs 133（115.8-147.8） mmHg [OR=1.729, 95%CI 0.517-2.941] and DBP （72±9） mmHg vs （82＋12） mmHg [OR=2.902, 95%C/ 1.144-3.414]}, high density {lipoprotein 1.7（1.4-2.1） mmol/L vs 1.4（1.2- 1.6） mmol/L [OR=-1.829, 95%CI -2.550-1.011]} total cholesterol （TC）/high density lipoprotein cholesterol {HDL 1.7（1.6-1.9） mmol/L vs 3.2（2.7-4.0） mmol/L [OR=0.299, 95%CI-0.453-1.052]}, inflammatory markers [hs-CRP, white blood cell （WBC） and blood platelet （PLT）] and decreased HDL compared to controls. As expected, hs-CRP level was significantly increased in the ERA group reflecting underlying inflammation. The hs-CRP level was significantly correlated with BMI, SBP DBP, and inflammation markers WBC and PLT, as well as inversely correlated with HDL which reflected the underlying inflammation. Further adjustment for hs- CR

关 键 词：关节炎 类风湿 炎症 心血管疾病 

分 类 号：R593.22[医药卫生—内科学] R54[医药卫生—临床医学]