Sedky Abdou Manal M, El Desouky Soha M, Helmy El Kaffas Khaled M, Ahmed Hassan Abeer M
Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Int J Rheum Dis. 2017 Mar;20(3):383-389. doi: 10.1111/1756-185X.12987. Epub 2016 Dec 30.
To detect premature atherosclerosis in systemic sclerosis (SSc) patients and its relation to disease parameters and traditional risk factors.
This study included 40 SSc patients and 40 healthy age and sex matched controls. All patients were subjected to full history taking, clinical examination, relevant laboratory and radiological investigations. Doppler ultrasonography (US) of the common carotid was performed to measure intima-media thickness (ccIMT) and Doppler US of the brachial artery was performed to measure flow mediated dilatation (FMD).
The mean value of ccIMT was 0.59 ± 0.2 mm in SSc patients and 0.51 ± 0.09 mm in controls and the difference was significant (P = 0.03). A statistically significant difference was found in mean brachial artery diameter before and after hyperemia, in flow change and in FMD between SSc patients and controls. ccIMT showed significant positive correlation with age, C-reactive protein (CRP), cholesterol, triglycerides and low density lipoprotein (P < 0.05). FMD showed significant positive correlation with daily dose of steroids (P = 0.04). Brachial artery diameter after hyperemia showed significant negative correlation with erythrocyte sedimentation rate (ESR). Peak systolic velocity before ischemia showed significant positive correlation with body mass index (BMI) and significant negative correlation with insulin level.
Our findings confirm the presence of premature atherosclerosis in SSc patients assessed by significant impairment of FMD, flow change and ccIMT, and it is associated with traditional cardiovascular risk factors such as age, dyslipidemia and obesity (BMI) as well as with the use of steroids and markers of inflammation such as CRP and ESR.
检测系统性硬化症（SSc）患者的早期动脉粥样硬化及其与疾病参数和传统危险因素的关系。
本研究纳入40例SSc患者以及40例年龄、性别相匹配的健康对照者。所有患者均进行了全面的病史采集、临床检查、相关实验室及影像学检查。采用多普勒超声检查颈总动脉以测量内膜中层厚度（ccIMT），采用多普勒超声检查肱动脉以测量血流介导的血管舒张功能（FMD）。
SSc患者的ccIMT平均值为0.59±0.2mm，对照组为0.51±0.09mm，差异具有统计学意义（P = 0.03）。在充血前后肱动脉直径、血流变化以及FMD方面，SSc患者与对照组之间存在统计学显著差异。ccIMT与年龄、C反应蛋白（CRP）、胆固醇、甘油三酯及低密度脂蛋白呈显著正相关（P < 0.05）。FMD与每日类固醇剂量呈显著正相关（P = 0.04）。充血后肱动脉直径与红细胞沉降率（ESR）呈显著负相关。缺血前收缩期峰值流速与体重指数（BMI）呈显著正相关，与胰岛素水平呈显著负相关。
我们的研究结果证实，通过FMD、血流变化和ccIMT的显著受损评估，SSc患者存在早期动脉粥样硬化，并且它与年龄、血脂异常和肥胖（BMI）等传统心血管危险因素以及类固醇的使用和CRP及ESR等炎症标志物有关。
