亚临床动脉粥样硬化的程度部分由炎症负荷预测：一项对类风湿性关节炎患者和匹配对照组进行的5年前瞻性研究。
The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls.
作者信息
Södergren Anna, Karp Kjell, Bengtsson Christine, Möller Bozena, Rantapää-Dahlqvist Solbritt, Wållberg-Jonsson Solveig
机构信息
From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
出版信息
J Rheumatol. 2015 Jun;42(6):935-42. doi: 10.3899/jrheum.140694. Epub 2015 Apr 15.
OBJECTIVE
This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.
METHODS
Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.
RESULTS
In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.
CONCLUSION
This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.
目的
这项前瞻性随访研究调查了与传统心血管疾病（CVD）风险因素及炎症相关的亚临床动脉粥样硬化情况，研究对象为诊断时招募的类风湿关节炎（RA）患者，并与对照组进行比较。
方法
连续招募被诊断为早期RA的患者进入一项前瞻性研究。从这些患者中，连续纳入一个年龄≤60岁的亚组（n = 71），在入组时（T0）和5年后（T5）进行内膜中层厚度（IMT）和血流介导的血管舒张（FMD）的超声测量。还纳入了年龄和性别匹配的对照组（n = 40）。
结果
在Wilcoxon符号秩检验中，与基线相比，RA患者在T5时IMT和FMD均显著加重，而对照组仅IMT显著增加。在RA患者的单变量线性回归分析中，T5时的IMT与年龄、收缩压（BP）、胆固醇、甘油三酯、系统性冠状动脉风险评估（SCORE）以及基线时的雷诺兹风险评分显著相关（p < 0.05）。同样，T5时的FMD与年龄、吸烟、收缩压、SCORE和雷诺兹风险评分显著负相关（p < 0.05）。一个来自多元线性回归模型的具有标准化预测值的模型，包括年龄、吸烟、BP和基线血脂，显著预测了5年后IMT的观察值。当还纳入5年期间28个关节疾病活动评分的曲线下面积时，IMT的观察值在很大程度上得到了预测。
结论
这项前瞻性研究发现RA患者亚临床动脉粥样硬化增加。在RA患者中，基线时的几种传统CVD风险因素显著预测了5年后亚临床动脉粥样硬化的程度。随着时间推移的炎症负荷增强了这种预测。
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