类风湿关节炎合并颈动脉粥样硬化的危险因素分析及与中医证型相关性研究  

Analysis of Risk Factors for Carotid Atherosclerosis in Rheumatoid Arthritis and its Correlation with TCM Syndrome

作　　者：刘一凡 杨月[1] 薛鸾[1] Liu Yifan;Yang Yue;Xue Luan(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《世界科学技术-中医药现代化》2021年第7期2269-2275,共7页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委员会青年科学基金项目(81704032):从程序性死亡分子信号通路研究补肾活血法对系统性红斑狼疮早发动脉粥样硬化的抗炎及免疫调节作用,负责人:杨月。

摘　　要：目的探究类风湿关节炎(rheumatoid arthritis,RA)合并颈动脉粥样硬化的危险因素及其与中测血脂水平,D二聚体,炎症急性反应物,RA相关抗体,双手X线平片,并进行DAS28-ESR疾病活动评分和中医辨证分型。分析各项指标、中医证型与颈动脉粥样硬化的相关性。计量资料组间比较采用方差分析,构成比检验采用χ2检验,影响因素分析采用Logistic回归分析,P <0.05为差异有统计学意义。结果 (1)Logistic回归分析发现,年龄> 50岁的中老年人群、甘油三酯及白介素6(interleukin-6,IL-6)异常升高及关节腔狭窄和/或骨破坏形成是RA合并颈动脉粥样硬化的危险因素。(2)在不同中医证型中,痰瘀痹阻证、肝肾不足证、气血两虚证的患者相较风湿痹阻证、寒湿痹阻证、湿热痹阻证,有更高的颈动脉粥样硬化发生率。结论 RA患者中,中老年人群、IL-6及甘油三酯水平升高、关节腔狭窄和/或骨破坏形成与颈动脉粥样硬化的发生有关,痰瘀痹阻证、肝肾不足证、气血两虚证的RA患者更易合并颈动脉粥样硬化。Objective To observe the risk factors for carotid atherosclerosis in rheumatoid arthritis and its correlation with TCM syndrome. Methods Totally 298 cases with rheumatoid arthritis were divided into plaque-group(n = 68) and non-plaque-group(n = 222) by the result of carotid ultrasound. The serum levels of triglycerides, total cholesterol, highdensity lipoprotein, low-density lipoprotein, D dimer, C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrullinated peptide antibody, inflammatory cytokines and the x-rays of hands were observed.Disease activity was assessed by the DAS28-ESR. TCM syndrome was assessed by clinical manifestations. The comparison of measurement data between groups was performed by analysis of variance, the component ratio test was performed by χ2 test, and the analysis of influencing factors was performed by logistic regression analysis. P < 0.05 indicated that the difference was statistically significant. Results(1) Logistic regression analysis showed that age > 50-year-old in the elderly population, with abnormal increase in triglycerides and IL-6 and with joint cavity narrowing and/or bone destruction in RA were the risk factors for carotid atherosclerosis.(2) Among the different TCM syndrome types,patients with phlegm and blood stasis obstruction syndrome, liver and kidney deficiency syndrome, and qi and blood deficiency syndrome have higher incidence of carotid plaque. Conclusion Elderly population, elevated IL-6 and triglyceride levels, articular cavity stenosis and/or bone destruction are related to carotid atherosclerosis in RA, while the RA patients with TCM syndrome of phlegm and blood stasis, liver and kidney deficiency and deficiency of both qi and blood are more likely to have carotid atherosclerosis.

关 键 词：类风湿关节炎 颈动脉粥样硬化 危险因素 中医证型 

分 类 号：R241.9[医药卫生—中医诊断学]