Hannawi Suad, Marwick Thomas H, Thomas Ranjeny
Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Arthritis Res Ther. 2009;11(2):R51. doi: 10.1186/ar2668. Epub 2009 Apr 6.
Patients with recent-onset rheumatoid arthritis (RA) have impaired brachial artery endothelial function compared with controls matched for age, sex and cardiovascular risk factors. The present study examined endothelium-dependent (flow-mediated dilatation (FMD)) and independent (glyceryl trinitrate (GTN)-mediated dilatation (GMD)) structural responses in early RA patients, and determined progress over one year.
Brachial artery FMD and GMD and carotid intima media thickness (cIMT) were studied using ultrasound in 20 patients diagnosed with early RA in whom symptoms had been present for less than 12 months, and in 20 control subjects matched for age, sex and established cardiovascular risk factors. FMD and GMD were re-assessed after 12 months in RA patients and the change in each parameter was calculated. Data were analysed by univariate regression.
Mean FMD and GMD were significantly lower in early RA patients at baseline than in controls, but each parameter significantly improved in one year. FMD and GMD responses were positively associated with each other. Patients' age, C-reactive protein (CRP) level and cIMT at baseline and CRP level at one year, were negatively associated with change in brachial responses in one year.
Patients with recent-onset RA have altered brachial artery responses signifying both functional and structural abnormalities. However, early control of inflammation may reduce arterial dysfunction and thus the tendency for atherosclerotic progression.
与年龄、性别及心血管危险因素相匹配的对照组相比，近期发病的类风湿关节炎（RA）患者肱动脉内皮功能受损。本研究检测了早期RA患者的内皮依赖性（血流介导的血管舒张（FMD））和非内皮依赖性（硝酸甘油（GTN）介导的血管舒张（GMD））结构反应，并确定了一年中的变化情况。
对20例诊断为早期RA且症状出现时间少于12个月的患者以及20例年龄、性别和已确定的心血管危险因素相匹配的对照者，使用超声研究肱动脉FMD和GMD以及颈动脉内膜中层厚度（cIMT）。对RA患者在12个月后重新评估FMD和GMD，并计算每个参数的变化。采用单变量回归分析数据。
早期RA患者基线时的平均FMD和GMD显著低于对照组，但每个参数在一年内均有显著改善。FMD和GMD反应呈正相关。患者的年龄、基线时的C反应蛋白（CRP）水平和cIMT以及一年时的CRP水平与一年内肱动脉反应的变化呈负相关。
近期发病的RA患者肱动脉反应改变，表明存在功能和结构异常。然而，早期控制炎症可能会减少动脉功能障碍，从而降低动脉粥样硬化进展的趋势。
