Carotti M, Salaffi F, Mangiacotti M, Cerioni A, Giuseppetti G M, Grassi W
Clinica Reumatologica, Università degli Studi di Ancona, Ospedale A. Murri, Jesi AN, Italia.
Reumatismo. 2007 Jan-Mar;59(1):38-49. doi: 10.4081/reumatismo.2007.38.
Patients with rheumatoid arthritis (RA) have a reduced life expectancy and high cardiovascular morbidity and mortality as compared to the general population. A number of possible factors for the atherogenesis in this disease have been described, such as homocysteine, altered serum levels of selected lipoproteins and treatment. Recent findings indicate that the systemic inflammation may contribute to the development of atherosclerosis and confer an additional risk for cardiovascular death among patients with RA. The aim of our study was to evaluate the ability of high resolution Bmode ultrasound and color Doppler to assess the existence of subclinical atherosclerosis in RA patients, measuring the intima-media thickness (IMT) and resistance index of the common carotid arteries.
Carotid IMT and carotid plaque were measured using high-resolution B-mode ultrasound in 40 patients with RA and 40 age- and sex-matched healthy persons. We used color Doppler ultrasound to assess vascular damage of the common carotid arteries and the resistance index (RI) was determined by analysis of the spectral waveforms. Serum total cholesterol, triglycerides-density lipoprotein cholesterol, low-density lipoprotein cholesterol, rheumatoid factor, body mass index (BMI), visual analogue scale (VAS) were determined in patients and controls. C-reactive protein (CRP) and the DAS28 were used to measure systemic inflammation.
Common carotid IMT were significantly higher (p=0.0009) in RA patients (0.83 +/- 0.23) compared with controls (0.66 +/- 0.22). In RA patients common carotid IMT was significantly correlated with serum total cholesterol (p=0.0008), low-density lipoprotein cholesterol (p=0.006), triglycerides (p=0.042), age (p=0.031) and disease duration (p=0.019). No significant correlation was found with clinical and laboratory parameters reflecting disease activity. The prevalence of plaques was higher in RA patients compared with controls (25% vs 12.5%). There was no significant difference in color Doppler findings, and in particular in RI, between patients and controls.
Our results confirm an accelerated atherosclerosis, as shown by increased common carotid IMT, in patients with RA compared with controls and it is related mainly to lipid levels. High-resolution B-mode ultrasound may be considered a promising, sensitive and non invasive tool for assessing the existence of subclinical atherosclerosis in RA patients.
与普通人群相比，类风湿关节炎（RA）患者的预期寿命缩短，心血管疾病的发病率和死亡率较高。已经描述了该疾病中动脉粥样硬化形成的一些可能因素，如高半胱氨酸、特定脂蛋白血清水平的改变以及治疗。最近的研究结果表明，全身炎症可能导致动脉粥样硬化的发展，并使RA患者面临心血管死亡的额外风险。我们研究的目的是评估高分辨率B型超声和彩色多普勒评估RA患者亚临床动脉粥样硬化存在的能力，测量颈总动脉的内膜中层厚度（IMT）和阻力指数。
使用高分辨率B型超声测量40例RA患者和40例年龄及性别匹配的健康人的颈动脉IMT和颈动脉斑块。我们使用彩色多普勒超声评估颈总动脉的血管损伤，并通过分析频谱波形确定阻力指数（RI）。测定患者和对照组的血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、类风湿因子、体重指数（BMI）、视觉模拟评分（VAS）。使用C反应蛋白（CRP）和DAS28测量全身炎症。
RA患者（0.83±0.23）的颈总动脉IMT显著高于对照组（0.66±0.22）（p = 0.0009）。在RA患者中，颈总动脉IMT与血清总胆固醇（p = 0.0008）、低密度脂蛋白胆固醇（p = 0.006）、甘油三酯（p = 0.042）、年龄（p = 0.031）和病程（p = 0.019）显著相关。与反映疾病活动的临床和实验室参数未发现显著相关性。RA患者的斑块患病率高于对照组（25%对12.5%）。患者和对照组在彩色多普勒检查结果，特别是RI方面没有显著差异。
我们的结果证实，与对照组相比，RA患者存在动脉粥样硬化加速，表现为颈总动脉IMT增加，且主要与血脂水平有关。高分辨率B型超声可被认为是评估RA患者亚临床动脉粥样硬化存在的一种有前景、敏感且无创的工具。
