Hollan Ivana, Scott Helge, Saatvedt Kjell, Prayson Richard, Mikkelsen Knut, Nossent Hans C, Kvelstad Ingjerd Lien, Liang Matthew H, Førre Oystein T
Hospital for Rheumatic Diseases, Lillehammer, Norway.
Arthritis Rheum. 2007 Jun;56(6):2072-9. doi: 10.1002/art.22690.
Several inflammatory rheumatic diseases are associated with accelerated atherosclerosis. Atherosclerosis may result from systemic and/or local vascular inflammation. The aim of this study was to evaluate the occurrence of chronic inflammatory infiltrates in the aortas of patients with and those without inflammatory rheumatic disease who had undergone coronary artery bypass graft (CABG) surgery, and to assess the relationship between the infiltrates and other factors thought to play a role in atherosclerosis, such as smoking.
Aortic specimens routinely removed during CABG surgery in 66 consecutive patients with inflammatory rheumatic disease and 51 control patients without inflammatory rheumatic disease were examined by light microscopy for the occurrence, location, and severity of chronic inflammatory infiltrates and atherosclerotic lesions.
Mononuclear cell infiltrates in the inner adventitia (apart from those localized along the epicardium) were more frequent in the group of patients with inflammatory rheumatic disease (47% versus 20%; P = 0.002, odds ratio [OR] OR 3.6, 95% confidence interval [95% CI] 1.6-8.5), and the extent of these infiltrates was greater. Multivariate analyses revealed that the occurrence of mononuclear cell infiltrates was associated with inflammatory rheumatic disease (OR 2.99, P = 0.020) and current smoking (OR 3.93, P = 0.012), and they were observed in 6 of 7 patients with a history of aortic aneurysm. Inflammatory infiltrates in the media were seen only in patients with inflammatory rheumatic disease. The frequency of atherosclerotic lesions, inflammation within the plaques, and epicardial inflammatory infiltrates in the 2 groups was equal.
Among aortic samples collected during CABG surgery, those obtained from patients with inflammatory rheumatic disease had more pronounced chronic inflammatory infiltration in the media and inner adventitia than those obtained from control patients. Current smoking was an independent predictor of chronic inner adventitial infiltrates. The infiltrates may represent an inflammatory process that promotes atherosclerosis and formation of aneurysms.
几种炎性风湿性疾病与动脉粥样硬化加速有关。动脉粥样硬化可能由全身和/或局部血管炎症引起。本研究的目的是评估接受冠状动脉旁路移植术（CABG）的炎性风湿性疾病患者和非炎性风湿性疾病患者主动脉中慢性炎性浸润的发生情况，并评估这些浸润与其他被认为在动脉粥样硬化中起作用的因素（如吸烟）之间的关系。
对连续66例炎性风湿性疾病患者和51例无炎性风湿性疾病的对照患者在CABG手术期间常规切除的主动脉标本进行光学显微镜检查，以观察慢性炎性浸润和动脉粥样硬化病变的发生、位置和严重程度。
炎性风湿性疾病患者组内膜外膜（不包括沿心外膜分布的那些）中的单核细胞浸润更为频繁（47%对20%；P = 0.002，比值比[OR]3.6，95%置信区间[95%CI]1.6 - 8.5），且这些浸润的程度更大。多因素分析显示，单核细胞浸润与炎性风湿性疾病（OR 2.99，P = 0.020）和当前吸烟（OR 3.93，P = 0.012）相关，并且在7例有主动脉瘤病史的患者中有6例观察到这种情况。中膜的炎性浸润仅在炎性风湿性疾病患者中可见。两组中动脉粥样硬化病变、斑块内炎症和心外膜炎性浸润的频率相同。
在CABG手术期间收集的主动脉样本中，来自炎性风湿性疾病患者的样本相比对照患者的样本，中膜和内膜外膜有更明显的慢性炎性浸润。当前吸烟是内膜外膜慢性浸润的独立预测因素。这些浸润可能代表促进动脉粥样硬化和动脉瘤形成的炎性过程。
