胰岛素抵抗在类风湿关节炎患者经颈动脉超声检测发现动脉粥样硬化频率增加中的作用

Role of insulin resistance in increased frequency of atherosclerosis detected by carotid ultrasonography in rheumatoid arthritis.

作者信息

Pamuk Omer Nuri, Unlü Ercüment, Cakir Necati

机构信息

Department of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey.

出版信息

J Rheumatol. 2006 Dec;33(12):2447-52.

PMID:17143979

Abstract

OBJECTIVE

We evaluated the presence of subclinical atherosclerosis and factors influencing atherosclerosis, including insulin resistance (IR), in patients with rheumatoid arthritis (RA).

METHODS

Sixty-three patients with RA and 34 controls were studied. Patients' cardiovascular risk factors were recorded; biochemical variables were determined. Intima-media thickness (IMT) of carotid arteries was determined by B-mode ultrasonography, and presence of atheromatous plaques was determined. IR was calculated according to the HOMA-IR homeostasis model.

RESULTS

There were no differences in atherosclerotic risk factors between patients with RA and controls. In the RA group, the median carotid IMT was 0.61 mm (range 0.56-0.74), greater than the 0.54 mm (range 0.50-0.64) in controls (p = 0.01). There was a tendency to a higher frequency of carotid plaques in the RA group compared to controls [12 RA patients (19%) vs 2 controls (5.9%); p = 0.10]. Multivariate regression analysis revealed the factors that had an independent effect on increased carotid IMT: age (p < 0.001), male sex (p = 0.01), and total cholesterol level (p = 0.02). In RA patients with plaques, age (64.5 vs 48 yrs; p = 0.005), carotid IMT (0.75 vs 0.60 mm; p = 0.001), frequency of hypertension (58.3% vs 23.5%; p = 0.03), and IR (83.3% vs 29.4%; p = 0.001) were higher. Multivariate logistic regression analysis showed that factors independently associated with the presence of plaques were IR (OR 15.85, 95% CI 2.23-112.89, p = 0.006) and age (OR 1.11, 95% CI 1.02-1.21, p = 0.02). In RA patients, HOMA-IR correlated with age (r = 0.26, p = 0.04), Health Assessment Questionnaire score (r = 0.28, p = 0.04), and concentrations of triglyceride (r = 0.39, p = 0.003) and cholesterol (r = 0.33, p = 0.02).

CONCLUSION

IR in the setting of active rheumatoid disease may contribute to mechanisms of accelerated atherogenesis observed in patients with RA.

摘要

目的

我们评估了类风湿关节炎（RA）患者亚临床动脉粥样硬化的存在情况以及影响动脉粥样硬化的因素，包括胰岛素抵抗（IR）。

方法

对63例RA患者和34例对照者进行了研究。记录患者的心血管危险因素；测定生化变量。通过B型超声检查确定颈动脉内膜中层厚度（IMT），并确定动脉粥样斑块的存在情况。根据HOMA-IR稳态模型计算IR。

结果

RA患者和对照者之间的动脉粥样硬化危险因素无差异。在RA组中，颈动脉IMT中位数为0.61mm（范围0.56 - 0.74），大于对照组的0.54mm（范围0.50 - 0.64）（p = 0.01）。与对照组相比，RA组颈动脉斑块的发生率有升高趋势[12例RA患者（19%）对2例对照者（5.9%）；p = 0.10]。多变量回归分析揭示了对颈动脉IMT增加有独立影响的因素：年龄（p < 0.001）、男性（p = 0.01）和总胆固醇水平（p = 0.02）。在有斑块的RA患者中，年龄（64.5岁对48岁；p = 0.005）、颈动脉IMT（0.75mm对0.60mm；p = 0.001）、高血压发生率（58.3%对23.5%；p = 0.03）和IR（83.3%对29.4%；p = 0.001）更高。多变量逻辑回归分析表明，与斑块存在独立相关的因素是IR（OR 15.85，95%CI 2.23 - 112.89，p = 0.006）和年龄（OR 1.11，95%CI 1.02 - 1.21，p = 0.02）。在RA患者中，HOMA-IR与年龄（r = 0.26，p = 0.04）、健康评估问卷评分（r = 0.28，p = 0.04）以及甘油三酯浓度（r = 0.39，p = 0.003）和胆固醇浓度（r = 0.33，p = 0.02）相关。