Dessein Patrick H, Norton Gavin R, Woodiwiss Angela J, Joffe Barry I, Wolfe Fred
Department of Rheumatology, Johannesburg Hospital and Milpark Hospital, Parktown, University of Witwatersrand, Johannesburg, South Africa.
J Rheumatol. 2007 May;34(5):943-51. Epub 2007 Apr 15.
To determine whether nontraditional risk factors increase the accuracy of predicting the presence of carotid artery plaque based on traditional cardiovascular risk factors only in patients with rheumatoid arthritis (RA).
We identified risk factors that were independently associated with ultrasonographically located plaque. In predicting carotid artery plaque, the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve for the combination of traditional and nontraditional risk factors was compared to the AUC of the ROC curve for traditional risk factors and nontraditional risk factors considered separately in 91 patients with RA.
Thirty-one (34%) patients had carotid artery plaque. The 3 traditional risk factors of age > 55 years, hypertension, and ever-smoking, and the 3 nontraditional risk factors of a disease duration > 8 years, polymorphonuclear cell count > 4.5 x 10(6)/l, and hypothyroidism were each independently associated with the presence of plaque (odds ratios 2.08-8.78; p = 0.001-0.02). The percentage of patients with plaque was 0, 10%, 50%, and 83% in patients with 0-1, 2, 3, and 4-6 of these risk factors, respectively. In predicting plaque, the AUC of the ROC curve for the combination of traditional and nontraditional risk factors (0.90 +/- 0.03) was greater than that for either traditional (0.80 +/- 0.05; p = 0.006) or nontraditional (0.80 +/- 0.04; p = 0.005) risk factors considered separately.
The combination of disease duration, polymorphonuclear cell counts, and thyroid status increased the accuracy of predicting subclinical atheroma in patients with RA. We believe that our findings merit external validation.
确定在类风湿关节炎（RA）患者中，非传统危险因素是否能提高仅基于传统心血管危险因素预测颈动脉斑块存在的准确性。
我们确定了与超声定位斑块独立相关的危险因素。在预测颈动脉斑块时，将91例RA患者中传统和非传统危险因素组合的受试者操作特征（ROC）曲线下面积（AUC）与分别考虑的传统危险因素和非传统危险因素的ROC曲线AUC进行比较。
31例（34%）患者有颈动脉斑块。年龄>55岁、高血压和曾经吸烟这3个传统危险因素，以及病程>8年、多形核细胞计数>4.5×10⁶/l和甲状腺功能减退这3个非传统危险因素均与斑块存在独立相关（比值比2.08 - 8.78；p = 0.001 - 0.02）。这些危险因素分别有0 - 1个、2个、3个和4 - 6个的患者中，有斑块患者的百分比分别为0%、10%、50%和83%。在预测斑块时，传统和非传统危险因素组合的ROC曲线AUC（0.90±0.03）大于单独考虑的传统危险因素（0.80±0.05；p = 0.006）或非传统危险因素（0.80±0.04；p = 0.005）的ROC曲线AUC。
病程、多形核细胞计数和甲状腺状态的组合提高了RA患者亚临床动脉粥样硬化预测的准确性。我们认为我们的发现值得外部验证。
