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类风湿关节炎中的心血管疾病:中国的药物与风险因素

Cardiovascular disease in rheumatoid arthritis: medications and risk factors in China.

作者信息

Li Chun, Wang X R, Ji H J, Zhang X Y, Li X F, Wang L Z, Wang C H, Wang Y F, Yang Rong, Wang G C, Lu Xin, Zhu Ping, Chen L N, Jin H T, Liu J T, Liu X Y, Sun Lin, Chen H Y, Wei Ping, Wang J X, Cui L F, Shu Rong, Liu B L, Zhang Z L, Li G T, Li Z B, Yang Jing, Li J F, Jia Bin, Zhang F X, Tao J M, Han S L, Lin J Y, Wei M Q, Liu X M, Ke Dan, Hu S X, Ye Cong, Yang X Y, Li Hao, Huang C B, Gao Ming, Lai Bei, Li X F, Song L J, Wang Yi, Wang X Y, Tang Y D, Su Yin, Mu Rong, Li Z G

机构信息

Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Beijing, 100044, China.

Department of Rheumatology and Immunology, Peking University Shougang Hospital, 9 Jinyuanzhuang Street, Beijing, 100144, China.

出版信息

Clin Rheumatol. 2017 May;36(5):1023-1029. doi: 10.1007/s10067-017-3596-7. Epub 2017 Mar 24.

Abstract

This study aims to assess the risk factors of cardiovascular disease (CVD) and to determine the association of traditional and biologic disease-modifying anti-rheumatic drugs (DMARDs) with risk for CVD in Chinese rheumatoid arthritis (RA) patients. A cross-sectional cohort of 2013 RA patients from 21 hospitals around China was established. Medical history of CVD was documented. The patients' social background, clinical manifestations, comorbidities, and medications were also collected. Of the 2013 patients, 256 had CVD with an incidence of 12.7%. Compared with non-CVD controls, RA patients with CVD had a significantly advanced age, long-standing median disease duration, more often male and more deformity joints. Patients with CVD also had higher rates of smoking, rheumatoid nodules, interstitial lung disease, and anemia. The prevalence of comorbidities, including hypothyroidism, diabetes mellitus (DM), hypertension, and hyperlipidemia, was also significant higher in the CVD group. In contrast, patients treated with methotrexate, hydroxychloroquine (HCQ), and TNF blockers had lower incidence of CVD. The multivariate analysis showed that the use of HCQ was a protective factor of CVD, while hypertension, hyperlipidemia, and interstitial lung disease were independent risk factors of CVD. Our study shows that the independent risk factors of CVD include hypertension, hyperlipidemia, and interstitial lung disease. HCQ reduces the risk of CVD in patients with RA.

摘要

本研究旨在评估心血管疾病(CVD)的危险因素,并确定传统和生物改善病情抗风湿药物(DMARDs)与中国类风湿关节炎(RA)患者CVD风险之间的关联。建立了一个来自中国各地21家医院的2013例RA患者的横断面队列。记录了CVD病史。还收集了患者的社会背景、临床表现、合并症和用药情况。在2013例患者中,256例患有CVD,发病率为12.7%。与非CVD对照组相比,患有CVD的RA患者年龄显著更大,疾病持续时间中位数更长,男性更多,关节畸形更多。患有CVD的患者吸烟、类风湿结节、间质性肺病和贫血的发生率也更高。CVD组中包括甲状腺功能减退、糖尿病(DM)、高血压和高脂血症在内的合并症患病率也显著更高。相比之下,接受甲氨蝶呤、羟氯喹(HCQ)和肿瘤坏死因子阻滞剂治疗的患者CVD发病率较低。多变量分析显示,使用HCQ是CVD的保护因素,而高血压、高脂血症和间质性肺病是CVD的独立危险因素。我们的研究表明,CVD的独立危险因素包括高血压、高脂血症和间质性肺病。HCQ可降低RA患者的CVD风险。

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