Department of Rheumatology and Clinical Immunology, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia.
Rheumatology (Oxford). 2010 Jun;49(6):1076-81. doi: 10.1093/rheumatology/kep456. Epub 2010 Mar 5.
To evaluate the extent of subclinical atherosclerosis in patients with RA and low cardiovascular risk by measuring intima-media thickness (IMT) of the carotid arteries and to determine factors associated with increased IMT.
IMT was measured by ultrasonography in 42 non-diabetic, normotensive, female RA patients and 32 matched healthy controls [age 45.3 (10.0) vs 45.2 (9.8) years] at common carotid arteries (CCAs), carotid bifurcation (BF) and internal carotid arteries (ICAs), bilaterally. Mean and maximal (max) IMTs were calculated from three measurements at each site. Clinical work-up included laboratory analyses, determination of the disease activity and evaluation of treatment.
RA patients had increased IMT (mm) in comparison with controls [CCA(max): 0.764 (0.148) vs 0.703 (0.100); CCA(mean): 0.671 (0.119) vs 0.621 (0.085); BF(max): 1.055 (0.184) vs 0.941 (0.161); BF(mean): 0.889 (0.168) vs 0.804 (0.124); ICA(max): 0.683 (0.108) vs 0.613 (0.093); ICA(mean): 0.577 (0.101) vs 0.535 (0.076)]. Parameters associated with IMT in RA patients were (correlation at x/6 measurement sites): age (6/6), BMI (2/6), smoking (2/6), RF concentration (2/6), sedimentation rate (1/6) and duration of MTX + chloroquine therapy (4/6; inverse correlation). Multivariate regression analysis revealed that RA is an independent risk factor for increased IMT. Factors correlating with IMT in the controls were: age (6/6), BMI (3/6), total cholesterol (5/6), low-density lipoprotein cholesterol (3/6), total/high-density lipoprotein cholesterol (2/6), triglycerides (1/6) and glycaemia (4/6).
Despite a favourable risk profile, our female RA patients had significantly enlarged carotid IMT than controls. RA itself was an independent risk factor for increased IMT. Impact of chronic inflammation on atherosclerosis was confirmed by negative correlation of IMT and duration of anti-inflammatory treatment.
通过测量颈动脉内膜-中层厚度（IMT）来评估低心血管风险的 RA 患者亚临床动脉粥样硬化的程度，并确定与 IMT 增加相关的因素。
对 42 名非糖尿病、血压正常的女性 RA 患者（年龄 45.3[10.0]岁）和 32 名匹配的健康对照者（年龄 45.2[9.8]岁）进行双侧颈总动脉（CCA）、颈动脉分叉处（BF）和颈内动脉（ICA）的超声检查，测量 IMT。在每个部位进行三次测量，计算平均和最大（max）IMT。临床检查包括实验室分析、疾病活动度评估和治疗评估。
与对照组相比，RA 患者的 IMT（mm）增加[CCA(max)：0.764（0.148）vs 0.703（0.100）；CCA(mean)：0.671（0.119）vs 0.621（0.085）；BF(max)：1.055（0.184）vs 0.941（0.161）；BF(mean)：0.889（0.168）vs 0.804（0.124）；ICA(max)：0.683（0.108）vs 0.613（0.093）；ICA(mean)：0.577（0.101）vs 0.535（0.076）]。与 RA 患者 IMT 相关的参数为（在 x/6 个测量部位的相关性）：年龄（6/6）、BMI（2/6）、吸烟（2/6）、RF 浓度（2/6）、沉降率（1/6）和 MTX+氯喹治疗时间（4/6；负相关）。多变量回归分析显示，RA 是 IMT 增加的独立危险因素。与对照组 IMT 相关的因素为：年龄（6/6）、BMI（3/6）、总胆固醇（5/6）、低密度脂蛋白胆固醇（3/6）、总/高密度脂蛋白胆固醇（2/6）、甘油三酯（1/6）和血糖（4/6）。
尽管 RA 患者的风险状况良好，但与对照组相比，她们的颈动脉 IMT 明显增大。RA 本身是 IMT 增加的独立危险因素。慢性炎症对动脉粥样硬化的影响通过 IMT 与抗炎治疗时间的负相关得到证实。
