Patel Dhruvkumar M, Patel Mukundkumar V, Sharma Kamal H, Patel Greshaben R, Patel Manish B, Shah Vipul V
Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India.
Zydus Medical College and Hospital, Dahod, Gujarat, India.
Curr Rheumatol Rev. 2019;15(3):229-233. doi: 10.2174/1573397114666180816112948.
Atherosclerosis, inflammation and coronary plaque destabilization are linked to each other. Infections due to various microbes may trigger Acute Coronary Syndrome (ACS) by systemic inflammation cascade.
We have evaluated the prevalence of Post Chikungunya Chronic Arthritis (PCCA) among 400 consecutive ACS patients (Case group) and compared with control group subjected to elective surgery by the prospective case-control observational study. Cases were excluded if standard criteria of ACS were not satisfied and in the control group if the patient suffered a Myocardial Infarction (MI) within 28 days of elective surgery. PCCA duration more than two years or serum IgM anti-CCP positive patients were also excluded from the case as well as a control group.
The case and control groups were similar except, less number of heart failure (O.R.7.3, 95% C.I. 3.3-15.9) and chronic kidney injury patients (O.R. 0.5, 95% C.I. 0.3-0.9) in the elective surgery (control) group. PCCA was present in 24 out of 400 ACS cases and 8 out of 400 control group. Among ACS case-patients, those suffering from PCCA tended to be younger and more often women, with more diabetes, hypertension, chronic kidney injury and high mean CRP. In unadjusted analysis PCCA was three times more common in the case versus control (O.R. 3.0, 95% C.I. 1.4- 6.4); results were indistinguishable after multidiscipline adjustment (O.R. 3.0, 95% C.I. 1.3-6.8).
PCCA is common among patients with ACS and post-infective systemic inflammation of PCCA may trigger plaque destabilization.
动脉粥样硬化、炎症与冠状动脉斑块不稳定相互关联。各种微生物感染可能通过全身炎症级联反应引发急性冠状动脉综合征（ACS）。
我们通过前瞻性病例对照观察研究，评估了400例连续ACS患者（病例组）中基孔肯雅热后慢性关节炎（PCCA）的患病率，并与接受择期手术的对照组进行比较。若不满足ACS的标准则排除病例组患者，若对照组患者在择期手术28天内发生心肌梗死（MI）则将其排除。病程超过两年的PCCA患者或血清IgM抗环瓜氨酸肽抗体阳性患者也被排除在病例组和对照组之外。
病例组和对照组相似，但择期手术（对照）组中，心力衰竭患者（比值比7.3，95%置信区间3.3 - 15.9）和慢性肾损伤患者（比值比0.5，95%置信区间0.3 - 0.9）较少。400例ACS病例中有24例存在PCCA，400例对照组中有8例存在PCCA。在ACS病例患者中，患有PCCA的患者往往更年轻，女性更多，糖尿病、高血压、慢性肾损伤更多见，平均CRP更高。在未调整分析中，PCCA在病例组中的发生率是对照组的三倍（比值比3.0，95%置信区间1.4 - 6.4）；多学科调整后结果无差异（比值比3.0，95%置信区间1.3 - 6.8）。
PCCA在ACS患者中很常见，PCCA的感染后全身炎症可能触发斑块不稳定。
