Şirin Özcan Ayşe Nur, Aslan Abdullah Nabi, Ünal Özlem, Ercan Karabekir, Küçükşahin Orhan
Department of Radiology, Ankara Atatürk Education and Research Hospital / Turkey.
Department of Cardiology, Ankara Atatürk Education and Research Hospital / Turkey.
Med Ultrason. 2017 May 10;19(3):288-294. doi: 10.11152/mu-949.
Cardiovascular (CV) disease is the reason for most mortality cases in RA and cannot be explained only by the presence of traditional CV risk factors. In this study, we aimed to investigate the relationship between local carotid stiffness (CS) parameters measured by a novel ultrasound method and inflammatory disease activity in rheumatoid arthritis (RA) patients. Material and methods: The study was conducted with 70 RA patients and 35 control subjects. According to their disease activity score (DAS-28), the RA patients were classified into active RA (n = 36; DAS-28 > 3.2) and inactive RA (n = 34; DAS-28 ≤ 3.2) groups. A novel non-invasive echo-tracking system was used to measure carotid intima-media thickness (C-IMT), diameter, pulsatile strain, distensibility, and carotid pulse wave velocity (PWV) on 128 sites of the common carotid artery. Erythrocytesedimentation rate (ESR) and C-reactive protein (CRP) levels were also determined.
Carotid PWV and IMT were significantly higher in the active RA patients (8.20±1.47 m/s and 6.88±1.50 mm, respectively) compared to the inactive group (6.06±1.21 mm and 7.32±1.19 m/s, respectively) and the control subjects (0.68±0.12 mm and 6.41±0.98, respectively). In all RA patients, a statistically significant correlation was found between carotid PWV and age (r=0.435, p<0.001), ESR (r=0.257, p=0.033), and DAS-28 (r=0.314, p=0.009). According to the multivariate logistic regression analysis, age, DAS-28, and ESR were independent predictors of CS.
A strong correlation was found between disease activity and local CS parameters in patients with RA. We also demonstrated that both active and inactive RA patients showed increased PWV values compared with the control subjects. This easily applicable and previously confirmed method can be used in future to assess cardiovascular risk in broad study populations from different risk groups.
心血管（CV）疾病是类风湿关节炎（RA）患者大多数死亡病例的原因，且不能仅通过传统CV危险因素的存在来解释。在本研究中，我们旨在探讨一种新型超声方法测量的局部颈动脉僵硬度（CS）参数与类风湿关节炎（RA）患者炎症疾病活动之间的关系。
本研究纳入70例RA患者和35例对照受试者。根据疾病活动评分（DAS-28），将RA患者分为活动期RA组（n = 36；DAS-28 > 3.2）和非活动期RA组（n = 34；DAS-28≤3.2）。使用一种新型无创回声跟踪系统测量颈总动脉128个部位的颈动脉内膜中层厚度（C-IMT）、直径、搏动应变、扩张性和颈动脉脉搏波速度（PWV）。还测定了红细胞沉降率（ESR）和C反应蛋白（CRP）水平。
与非活动期组（分别为6.06±1.21 mm和7.32±1.19 m/s）和对照受试者（分别为0.68±0.12 mm和6.41±0.98）相比，活动期RA患者的颈动脉PWV和IMT显著更高（分别为8.20±1.47 m/s和6.88±1.50 mm）。在所有RA患者中发现，颈动脉PWV与年龄（r = 0.435，p < 0.001）、ESR（r = 0.257，p = 0.033）和DAS-28（r = 0.314，p = 0.009）之间存在统计学显著相关性。根据多因素逻辑回归分析，年龄、DAS-28和ESR是CS的独立预测因素。
在RA患者中发现疾病活动与局部CS参数之间存在强相关性。我们还证明，与对照受试者相比，活动期和非活动期RA患者的PWV值均升高。这种易于应用且先前已得到证实的方法未来可用于评估来自不同风险组的广泛研究人群中的心血管风险。
