尿白蛋白/肌酐比水平检测在类风湿关节炎患者亚临床动脉粥样硬化中的临床意义  

Clinical significance of urinary albumin/creatinine ratio in subclinical atherosclerosis in patients with rheumatoid arthritis

作　　者：韦彩雯 杨丽丽 张伶俐 曾婷 WEI Caiwen;YANG Lili;ZHANG Lingli;ZENG Ting(Department of General Medicine,Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai,202150,China;Lincang City Linxiang District Antdui Township Health Center,Lincang,Yunnan,677005,China;Department of Hematology and Rheumatolog,Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai,202150,China)

机构地区：[1]上海健康医学院附属崇明医院全科医学科,上海202150 [2]临沧市临翔区蚂蚁堆乡卫生院,云南临沧677005 [3]上海健康医学院附属崇明医院血液风湿科,上海202150

出　　处：《当代医学》2024年第17期112-117,共6页Contemporary Medicine

基　　金：上海市崇明区科学技术委员会科技项目(CKY2018-13)。

摘　　要：目的探讨类风湿关节炎(rheumatoidarthritis,RA)患者尿白蛋白/肌酐比水平与亚临床动脉粥样硬化的相关性。方法选取2019年1月至2020年12月上海健康医学院附属崇明医院收治的80例RA患者作为RA组,根据颈动脉超声检查颈动脉内膜中层厚度(intima-me-dia thickness,IMT)结果将RA患者分为斑块组(n=45)与无斑块组(n=35),另选取同期本院80名健康体检者作为健康对照组。比较RA组和健康对照组、斑块组与无斑块组血细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、血脂[总胆固醇(to-tal cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)]、稳态模型评估-胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)、类风湿因子(rheumatoid factor,RF)、抗环瓜氨酸抗体(anti-cyclic citrulline peptide antibody,ACCP)、尿白蛋白/肌酐比,Pearson相关分析RA组患者尿白蛋白/肌酐比水平与病程、ESR、CRP、血脂、HOMA-IR、RF、ACCP、药物使用情况、颈动脉IMT之间的相关性,并分析影响RA患者颈动脉IMT的因素。结果RA组ESR、CRP、HOMA-IR、RF、ACCP水平及尿白蛋白/肌酐比均高于健康对照组,差异有统计学意义(P<0.05)。斑块组病程、吸烟史、糖皮质激素使用时间均长于无斑块组,HOMA-IR、RF、ACCP水平及尿白蛋白/肌酐比均高于无斑块组,差异有统计学意义(P<0.05)。RA患者中尿白蛋白/肌酐比水平与病程、HOMA-IR、RF、ACCP、颈动脉IMT和糖皮质激素使用时间呈正相关(r>0,P<0.05)。多元逐步Logistic回归分析显示,病程、HOMA-IR、ACCP和尿白蛋白/肌酐比为影响颈动脉IMT的独立相关因素(P<0.05)。结论尿白蛋白/肌酐比与颈动脉IMT密切相关,可作为RA患者亚临床动脉粥样硬化的独立预测因子,为RA防治动脉粥样硬化及其大血管�Objective To investigate urinary albumin/creatinine ratio in patients with rheumatoid arthritis(RA)and its correlation with subclinical atherosclerosis.Methods 80 patients with RA were admitted to Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January 2019 to December 2020 as the RA group,and they were divided into the plaque group(n=45)and the plaque-free group(n=35)according to results of carotid artery intima-media thickness(IMT)by receiving carotid artery ultrasound examination,another 80 healthy individuals who underwent physical examinations during the same period in our hospital were selected as the healthy control group.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),blood lipid(total cholesterol[TC],triglyceride[TG],high density lipoprotein cholesterol[HDL-C],low density lipoprotein cholesterol[LDL-C]),homeostatic model assessment of insulin resistance(HOMA-IR),rheumatoid factor(RF),anti-cyclic citrulline peptide antibody(ACCP)and urine albumin/creatinine ratio were compared between the RA group and the healthy control group,the plaque group and the non plaque group,the correlation between urinary albumin/creatinine ratio and disease course,ESR,CRP,blood lipid,HOMA-IR,RF,ACCP,drug use and carotid IMT in the RA group was analyzed by Pearson correlation analysis,and the factors affecting carotid IMT in RA patients were analyzed.Results The levels of ESR,CRP,HOMA-IR,RF,ACCP and urinary albumin/creatinine ratio in the RA group were higher than those in the healthy control group,and the differences were statistically significant(P<0.05).The course of disease,smoking history and duration of glucocorticoid use in the plaque group were longer than those in the non-plaque group,and the levels of HOMA-IR,RF,ACCP and urinary albumin/creatinine ratio were higher than those in the non-plaque group,and the differences were statistically significant(P<0.05).Urinary albumin/creatinine ratio was positively correlated with disease duration,HOMA-IR,RF,ACCP,carotid

关 键 词：类风湿关节炎 动脉粥样硬化 尿白蛋白/肌酐比 

分 类 号：R593.22[医药卫生—内科学]