高敏心肌肌钙蛋白 I 在类风湿关节炎患者中升高，与心血管危险因素和炎症无关。

High-sensitivity cardiac troponin-I is elevated in patients with rheumatoid arthritis, independent of cardiovascular risk factors and inflammation.

机构信息

Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.

出版信息

PLoS One. 2012;7(6):e38930. doi: 10.1371/journal.pone.0038930. Epub 2012 Jun 28.

DOI:10.1371/journal.pone.0038930

PMID:22761714

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3386265/

Abstract

OBJECTIVES

We examined the hypothesis that cardiac-specific troponin-I (cTn-I), a biomarker of myocardial injury, is elevated in patients with rheumatoid arthritis (RA).

BACKGROUND

RA patients have an increased incidence of heart failure (HF). Chronic myocardial injury in RA may be a mechanism for the development of HF.

METHODS

We compared cTn-I concentrations measured by high-sensitivity immunoassay in 164 patients with RA and 90 controls, excluding prior or active heart failure. We examined the relationship between cTn-I concentrations and cardiovascular risk factors, inflammation, and coronary artery calcium score (CACS), a measure of coronary atherosclerosis.

RESULTS

cTn-I concentrations were 49% higher in patients with RA (median 1.15 pg/mL [IQR 0.73-1.92] than controls (0.77 pg/mL 0.49-1.28. The difference remained statistically significant after adjustment for demographic characteristics (P = 0.002), further adjustment for cardiovascular (CV) risk factors (P = 0.004), inflammatory markers (P = 0.008), and in a comprehensive model of CV risk factors and inflammatory markers (P = 0.03). In patients with RA, cTn-I concentrations were positively correlated with age (rho = 0.359), Framingham risk score (FRS) (rho = 0.366), and systolic blood pressure (rho = 0.248 (all P values ≤ 0.001)), but not with measures of inflammation or RA drug therapies. cTn-I was significantly correlated with CACS in RA in univariate analysis, but not after adjustment for age, race, sex and FRS (P = 0.79). Further model adjustments for renal function and coronary artery disease confirmed the significance of the findings.

CONCLUSION

High-sensitivity cTn-I concentrations are elevated in patients with RA without heart failure, independent of cardiovascular risk profile and inflammatory markers. Elevated troponin concentrations in RA may indicate subclinical, indolent myocardial injury.

摘要

目的

我们检验了这样一个假设，即心肌损伤标志物心脏型肌钙蛋白 I（cTn-I）在类风湿关节炎（RA）患者中升高。

背景

RA 患者心力衰竭（HF）的发生率增加。RA 中的慢性心肌损伤可能是 HF 发展的一种机制。

方法

我们比较了 164 例 RA 患者和 90 例对照者（排除既往或活动性 HF）的高敏免疫分析法检测的 cTn-I 浓度。我们检查了 cTn-I 浓度与心血管危险因素、炎症和冠状动脉钙评分（CACS）之间的关系，CACS 是冠状动脉粥样硬化的一种测量方法。

结果

RA 患者的 cTn-I 浓度高 49%（中位数 1.15pg/ml[IQR 0.73-1.92]比对照组（0.77pg/ml[0.49-1.28]）（P<0.001）。在调整了人口统计学特征后，差异仍有统计学意义（P=0.002），进一步调整了心血管（CV）危险因素（P=0.004）、炎症标志物（P=0.008）和 CV 危险因素和炎症标志物的综合模型（P=0.03）。在 RA 患者中，cTn-I 浓度与年龄（rho=0.359）、弗雷明汉风险评分（FRS）（rho=0.366）和收缩压（rho=0.248）呈正相关（所有 P 值均≤0.001），但与炎症标志物或 RA 药物治疗无关。在单变量分析中，cTn-I 与 RA 患者的 CACS 显著相关，但在调整年龄、种族、性别和 FRS 后不相关（P=0.79）。进一步调整肾功能和冠状动脉疾病的模型确认了这些发现的意义。