[类风湿关节炎中的心血管疾病]

Popkova T V, Khelkovskaia A N, Mach E S, Aleksandrova E N, Novikov A A, Novikova D S, Nasonov E L

Ter Arkh. 2007;79(5):9-14.

AIM

To examine the significance of conventional cardiovascular factors of risk and immunoinflammatory markers in development of vascular atherosclerosis in rheumatoid arthritis (RA).

MATERIAL AND METHODS

Conventional cardiovascular risk factors were evaluated in 103 RA patients (85 females and 18 males, mean age 46.3 years, duration of the disease 75 months). Forty six controls (32 females and 14 males) had no rheumatic diseases. Vascular atherosclerosis was diagnosed at ultrasonic scanning of the carotid arteries. Highly sensitive C-reactive protein (hsCRP) concentration in the blood serum was measured with highly sensitive enzyme immunoassay.

RESULTS

No differences by the rate of conventional cardiovascular risk factors between the groups were identified except arterial hypertension. Cardiovascular complications (ischemic heart disease, myocardial infarction, transient ischemic attacks) occurred more frequently in RA patients. Intima/media complex (IMC) thickness differences between the groups were not registered. Atherosclerotic plaques were detected more often in RA patients. In RA patients there was a correlation between IMC thickness in the carotid arteries and age (p = 0.00001), systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.01), concentration of blood cholesterol (C) (p = 0.03) and total coronary risk (TCR) (p = 0.003). Correlation between carotid artery IMC thickness, duration and activity of the disease, RA systemic manifestations was not detected (p > 0.05). A mean concentration of hsCRP in RA was higher than in the controls: 2.8 (4.4-25.6) mg/l and 1.3 (0.6-2.7) mg/ml, respectively (p = 0.001). A positive correlation existed between concentration of hsCRP and DAS4 (p = 0.0004) and negative--with C concentration (p = 0.01), LDL C, HDL C (p = 0.02). Increased concentration of hsCRP, IMC thickness in the carotid arteries, existence of atherosclerotic plaques and clinical picture of vascular atherosclerosis related insignificantly.

CONCLUSION

RA patients often suffer from cardiovascular pathology. Immunological markers of inflammation, primarily, hsCRP, in addition to conventional cardiovascular risk factors are essential in development of vascular atherosclerosis.

目的

探讨类风湿关节炎（RA）患者中传统心血管危险因素及免疫炎症标志物在血管动脉粥样硬化发生发展中的意义。

材料与方法

对103例RA患者（85例女性，18例男性，平均年龄46.3岁，病程75个月）进行传统心血管危险因素评估。46例对照者（32例女性，14例男性）无风湿性疾病。通过颈动脉超声扫描诊断血管动脉粥样硬化。采用高敏酶免疫法测定血清中高敏C反应蛋白（hsCRP）浓度。

结果

除动脉高血压外，两组间传统心血管危险因素发生率无差异。RA患者心血管并发症（缺血性心脏病、心肌梗死、短暂性脑缺血发作）更为常见。未发现两组间内膜/中膜复合体（IMC）厚度差异。RA患者中动脉粥样硬化斑块检出更为频繁。在RA患者中，颈动脉IMC厚度与年龄（p = 0.00001）、收缩压（p = 0.001）、舒张压（p = 0.01）、血胆固醇（C）浓度（p = 0.03）及总冠状动脉风险（TCR）（p = 0.003）之间存在相关性。未检测到颈动脉IMC厚度与疾病病程、活动度及RA全身表现之间的相关性（p > 0.05）。RA患者hsCRP的平均浓度高于对照组：分别为2.8（4.4～25.6）mg/l和1.3（0.6～2.7）mg/ml（p = 0.001）。hsCRP浓度与疾病活动度评分（DAS4）呈正相关（p = 0.0004），与C浓度、低密度脂蛋白胆固醇（LDL C）、高密度脂蛋白胆固醇（HDL C）呈负相关（p = 0.01、p = 0.02）。hsCRP浓度升高、颈动脉IMC厚度增加、动脉粥样硬化斑块的存在与血管动脉粥样硬化的临床表现之间无显著相关性。