From the Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Rheumatol. 2013 Nov;40(11):1897-904. doi: 10.3899/jrheum.130162. Epub 2013 Sep 15.
The prevalence of metabolic syndrome (MetS) tends to be high among rheumatic patients, and cardiovascular disease is the leading cause of death in these conditions. We aimed to determine the prevalence of MetS in patients with Takayasu arteritis (TA) and its association with risk factors and adipokine and cytokine levels.
A cross-sectional study was conducted in 45 consecutive women with TA and 47 healthy controls matched by age and body mass index.
The prevalence of MetS (International Diabetes Federation/American Heart Association criteria) was higher in TA compared to controls (33.34 vs 8.51%, p = 0.003). Patients with TA had a higher frequency of hypertension (p < 0.001) and dyslipidemia (p = 0.001) and higher levels of insulin (p = 0.021), homeostasis model assessment index (p = 0.024), apolipoprotein E (p = 0.029), resistin (p = 0.018), and C-reactive protein (CRP, p < 0.001) compared to healthy subjects, with similar levels of adiponectin and plasminogen activator inhibitor-1 (PAI-1; p > 0.05). Further analysis of patients with TA with and without MetS revealed a higher frequency of overweight/obesity (66.66 vs 26.66%, p = 0.022), higher Framingham score ≥ 1 (p = 0.032), and lower adiponectin levels (20.37 ± 21.16 vs 38.64 ± 22.62 μg/ml, p = 0.022) in the patients with MetS. No differences were found regarding disease duration, activity, glucocorticoid use, resistin, and PAI-1 levels in the 2 groups of patients with TA (p > 0.05). Patients with and without MetS showed no differences in cytokine levels [interleukin 12 (IL-12, IL-1a, IL-6) and tumor necrosis factor-α]. IL-6 had a positive Pearson correlation with CRP only in TA patients with MetS (r = 0.57; p = 0.050).
A high prevalence of MetS was observed in patients with TA and this comorbidity seems to identify a subgroup of overweight/obese patients with high cardiovascular risk without a significant association with disease status. Further longitudinal studies are necessary to observe the effects of controlling this modifiable risk factor in the quality of life and survival of patients with TA.
代谢综合征（MetS）在风湿患者中较为常见，而心血管疾病是这些情况下的主要死因。本研究旨在确定 Takayasu 动脉炎（TA）患者中 MetS 的患病率及其与危险因素、脂肪因子和细胞因子水平的关系。
对 45 例连续的 TA 女性患者和 47 例年龄和体重指数匹配的健康对照者进行横断面研究。
与对照组相比（33.34%比 8.51%，p = 0.003），TA 患者 MetS（国际糖尿病联合会/美国心脏协会标准）患病率更高。TA 患者高血压（p < 0.001）和血脂异常（p = 0.001）的频率更高，胰岛素（p = 0.021）、稳态模型评估指数（p = 0.024）、载脂蛋白 E（p = 0.029）、抵抗素（p = 0.018）和 C 反应蛋白（CRP，p < 0.001）水平更高，而脂联素和纤溶酶原激活物抑制剂-1（PAI-1；p > 0.05）水平相似。对有和无 MetS 的 TA 患者的进一步分析显示，超重/肥胖的频率更高（66.66%比 26.66%，p = 0.022），Framingham 评分≥1 的频率更高（p = 0.032），脂联素水平更低（20.37 ± 21.16 比 38.64 ± 22.62 μg/ml，p = 0.022）。两组 TA 患者在疾病持续时间、活动度、糖皮质激素使用、抵抗素和 PAI-1 水平方面无差异（p > 0.05）。有和无 MetS 的 TA 患者的细胞因子水平[白细胞介素 12（IL-12、IL-1a、IL-6）和肿瘤坏死因子-α]无差异。TA 患者中仅 MetS 患者的 IL-6 与 CRP 呈正 Pearson 相关（r = 0.57；p = 0.050）。
TA 患者 MetS 患病率较高，这种合并症似乎可以识别出一组超重/肥胖、心血管风险较高的患者，但与疾病状态无明显相关性。需要进一步的纵向研究来观察控制这种可改变的危险因素对 TA 患者生活质量和生存的影响。
