Giles Jon T, Allison Matthew, Blumenthal Roger S, Post Wendy, Gelber Allan C, Petri Michelle, Tracy Russell, Szklo Moyses, Bathon Joan M
Johns Hopkins University, Baltimore, Maryland 21224, USA.
Arthritis Rheum. 2010 Nov;62(11):3173-82. doi: 10.1002/art.27629.
Abdominal adiposity, especially visceral adiposity, is emerging as a recognized cardiometabolic risk factor. This study was undertaken to investigate how abdominal fat is distributed in rheumatoid arthritis (RA), and its RA-related determinants.
Men and women with RA were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis. Participants underwent anthropometric studies and quantification of visceral and subcutaneous fat areas (VFA and SFA) using abdominal computed tomography.
A total of 131 RA patients were compared with 121 controls. Despite similar body mass index and waist circumference between the RA and control groups, the adjusted mean VFA was 45 cm2 higher (+51%) in male RA patients versus male controls (P = 0.005), but did not significantly differ by RA status in women. The adjusted mean SFA was 119 cm2 higher (+68%) in female RA patients versus female controls (P < 0.001), but did not significantly differ by RA status in men. Elevated VFA (≥75th percentile) was associated with a significantly higher adjusted probability of having an elevated fasting glucose level, hypertension, or meeting the composite definition of the metabolic syndrome in the RA group compared with controls. Within the RA group, rheumatoid factor seropositivity and higher cumulative prednisone exposure were significantly associated with a higher mean adjusted VFA. Higher C-reactive protein levels and lower Sharp/van der Heijde scores were significantly associated with both VFA and SFA.
The distribution of abdominal fat differs significantly by RA status. Higher VFA in men with RA, and the more potent association of VFA with cardiometabolic risk factors in men and women with RA, may contribute to cardiovascular risk in RA populations.
腹部肥胖，尤其是内脏脂肪肥胖，正逐渐成为一种公认的心脏代谢风险因素。本研究旨在调查类风湿关节炎（RA）患者腹部脂肪的分布情况及其与RA相关的决定因素。
将患有RA的男性和女性与动脉粥样硬化多族裔研究中的非RA对照者进行比较。参与者接受了人体测量研究，并使用腹部计算机断层扫描对内脏和皮下脂肪面积（VFA和SFA）进行量化。
共对131例RA患者和121例对照者进行了比较。尽管RA组和对照组之间的体重指数和腰围相似，但男性RA患者的调整后平均VFA比男性对照者高45平方厘米（+51%）（P = 0.005），但在女性中，VFA并未因RA状态而有显著差异。女性RA患者的调整后平均SFA比女性对照者高119平方厘米（+68%）（P < 0.001），但在男性中，SFA并未因RA状态而有显著差异。与对照组相比，RA组中VFA升高（≥第75百分位数）与空腹血糖水平升高、高血压或符合代谢综合征综合定义的调整后概率显著更高相关。在RA组内，类风湿因子血清阳性和更高的累积泼尼松暴露量与更高的平均调整后VFA显著相关。更高的C反应蛋白水平和更低的Sharp/van der Heijde评分与VFA和SFA均显著相关。
腹部脂肪的分布因RA状态而有显著差异。RA男性患者的VFA较高，以及RA男性和女性患者中VFA与心脏代谢风险因素的更强关联，可能导致RA人群出现心血管风险。
