类风湿关节炎患者主动脉钙化积分研究  

The aortic calcification in patients with rheumatoid arthritis

作　　者：王茜[1,4] 孙明姝 刘莹爽[1] 高耸 李慧[3] Wang Qian;Sun Mingshu;Liu Yingshuang;Gao Song;Li Hui(Department of Rheumatology and Clinical Immunology,the Affiliated Hospital of Qingdao University,Shandong 266003,China;Department of Radiology,the Affiliated Hospital of Qingdao University,Shandong 266003,China;Department of Health Examination Center,the Affiliated Hospital of Qingdao University,Shandong 266003,China;Department of Rheumatology,Huashan Hospital,Fudan University,China)

机构地区：[1]青岛大学附属医院风湿免疫科,266003 [2]青岛大学附属医院放射科,266003 [3]青岛大学附属医院体检中心,266003 [4]复旦大学附属华山医院风湿免疫科

出　　处：《中华风湿病学杂志》2019年第5期289-294,共6页Chinese Journal of Rheumatology

基　　金：国家自然科学基金(81871288);山东省自然科学基金(ZR2018MH015).

摘　　要：目的研究RA患者主动脉钙化积分水平,及其与病程、疾病活动度、治疗时间等相关指标的关系。方法研究对象为连续性纳入的单一三级甲等医院风湿免疫科住院RA患者(RA组)及该院同期健康体检者(对照组),排除吸烟及饮酒嗜好者、糖尿病、高血压、冠心病、肿瘤、急慢性感染、其他自身免疫病及肝肾功能不全者。所有研究对象行256层螺旋CT平扫,应用HeartBeat-CS软件计算升主动脉、主动脉弓和胸主动脉动脉钙化积分之和代表主动脉钙化积分;收集2组人口学资料及病例组临床资料。运用SPSS17.0软件进行统计分析,采用独立t检验、Mann-WhitneyU检验、Spearman相关分析和χ^2检验进行统计分析。结果研究共纳入RA组100例,对照组60名,2组的年龄及性别组成差异无统计学意义(t=1.031,χ^2=0.430,P>0.05)。RA组主动脉钙化积分高于对照组[19.4(3.3,190.0)与2.1(1.9,18.0),U=1579.5,P<0.01];RA组主动脉钙化积分与年龄、病程、CRP、TC和LDL-C呈正相关(分别为r=0.729,P<0.01;r=0.227,P=0.023;r=0.229,P=0.022;r=0.220,P=0.028;r=0.224,P=0.014),而与治疗时间、关节压痛指数、关节肿胀指数、ESR、RF、抗CCP抗体、DAS28(CRP)、DAS28(ESR)、TG和HDL-C无关;对照组主动脉钙化积分亦与年龄呈正相关(r=0.465,P<0.01),与TC、TG、HDL-C、LDL-C无关。结论RA患者较年龄、性别匹配的普通人群更易合并主动脉钙化,其水平与病程、CRP、TC、LDL-C水平相关,提示系统性慢性炎症是导致RA发生主动脉钙化的重要原因。Objective To observe the aortic calcification level in patients with rheumatoid arthritis (RA), and to analyze the relationships between aortic calcification and some RA disease related presentations. Methods RA patients (RA group) were all in-patients consecutively recruited from the Department of Rheumatology in one single tertiary hospital, and healthy subjects (control group) were individuals for check-up from the same hospital at the same time. Subjects with long-term smoking and drinking history, diabetes, hypertension, coronary heart disease, cancer, active or chronic infection, other autoimmune diseases and liver or kidney dysfunction were excluded in both groups. The aortic calcification scores (including ascending aorta, arcus aorta and aorta thoracica) were obtained automatically by 256-slice spiral CT scanner using the Heart Beat-CS program. Statistical package from Soci-science (SPSS) 17.0 software was used for data analysis. Student's t test, Mann-Whitney U test, Spearman test and χ^2 test were used. Results One hundred RA patients and 60 healthy subjects were selected, and there were no differences of age [(53±10) vs (51±8),t=1.031, P=0.304) and gender compositions [male 40(40%) vs 25(41%),χ^2=0.430, P=0.869) between the two groups. The aortic calcification score in the RA group was higher than that in the control group [19.4(3.3, 190.0) vs 2.1(1.9, 18.0), U=1 579.5, P<0.01]. In RA group, the calcification score was positively correlated with age (r=0.729, P<0.01), course of disease (r=0.227, P=0.023), C-reactive protein (CRP)(r=0.229, P=0.022), total cholesterol (TC)(r=0.220, P=0.028) and low density lipoprotein cholesterol (LDL-C)(r=0.224, P=0.014), but not related with treatment duration, number of tender joints and swollen joints, erythrocyte sedimentation rate, rheumatoid factor, anti-CCP antibody, DAS-28(CRP), DAS-28(ESR), triglyceride(TG) and high density lipoprotein cholesterol(HDL-C). The aortic calcification was also positively correlated with age in control group(r=0.465, P<0.01), bu

关 键 词：关节炎 类风湿 血管钙化 断层扫描 螺旋计算机 钙化积分 

分 类 号：R593.22[医药卫生—内科学]