Faculty of Medicine, Department of Rheumatology, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, Plovdiv, Bulgaria.
Faculty of Medicine, Department of Cardiosurgery, Clinic of Cardiac Surgery and Vessels Surgery, UMHAT "Sv.Georgy", Medical University of Plovdiv, Plovdiv, Bulgaria.
Rheumatol Int. 2019 Oct;39(10):1723-1732. doi: 10.1007/s00296-019-04367-9. Epub 2019 Jul 11.
The mechanisms responsible for increased cardiovascular risk in patients with rheumatoid arthritis (RA) involve local and systemic inflammatory processes. We aimed to compare inflammatory markers and mortality risk in patients with acute coronary syndrome (ACS) with and without RA. The study involved 95 ACS patients (46 with RA and 49 without RA) and 40 healthy controls. Serum levels of Receptor Activator of Nuclear Factor Kappa B Ligand (sRANKL), Osteoprotegerin (sOPG), high-sensitivity C-reactive protein (hs-CRP) and high-sensitivity Tropinin I (hs-TnI) were tested in all participants. Additionally, ACS patients were assessed on RANKL expression (exRANKL) on coronary arteries and mortality risk on the Global Registry of Acute Coronary Events scale (GRACE). exRANKL was established in 35 (76%) ACS patients with RA, vs. 19 (39%) patients without RA, p < 0.001. RA patients had significantly higher levels of sRANKL and sOPG at 24 h and 48 h compared to ACS patients without RA and healthy controls (sRANKL 24 h: 121.33 vs. 51.67 vs. 36.94, p = 0.019; sRANKL 48 h: 89.21 vs. 36.95 vs. 36.94, p = 0.004; sOPG 24 h: 207.71 vs. 69.39 vs. 111.91, p < 0.001; sOPG 48 h: 143.36 vs. 69.38 vs. 111.91, p < 0.001). RA patients had significantly higher RANKL:OPG ratio at 48 h (0.062 vs. 0.53 vs. 0.33, p < 0.001), hs-CRP (28.82 vs. 23.67 vs. 2.60, p < 0.001) and hs-TnI (0.90 vs. 0.76 vs. 0.012). GRACE risk score was significantly higher in RA patients vs. those without RA (140.45 vs. 125.50, p = 0.030) and correlated with exRANKL, RANKL:OPG, hs-CRP, and hs-TnI. Our results indicate that exRANKL, inflammatory markers and mortality risk are amplified in ACS patients with RA compared to ACS patients without RA.
负责增加类风湿关节炎（RA）患者心血管风险的机制涉及局部和全身炎症过程。我们旨在比较急性冠状动脉综合征（ACS）患者和无 RA 的 ACS 患者的炎症标志物和死亡率风险。该研究纳入了 95 例 ACS 患者（46 例合并 RA，49 例无 RA）和 40 例健康对照者。所有参与者均检测了核因子 Kappa B 受体激活物配体（sRANKL）、骨保护素（sOPG）、高敏 C 反应蛋白（hs-CRP）和高敏肌钙蛋白 I（hs-TnI）的血清水平。此外，根据全球急性冠状动脉事件登记处（GRACE）量表评估 ACS 患者的 RANKL 表达（exRANKL）和死亡率风险。在 35 例（76%）RA 合并 ACS 患者中建立了 exRANKL，而在 19 例（39%）无 RA 的 ACS 患者中未建立，p<0.001。与无 RA 的 ACS 患者和健康对照组相比，RA 患者在 24 小时和 48 小时时的 sRANKL 和 sOPG 水平明显更高（sRANKL 24 小时：121.33 比 51.67 比 36.94，p=0.019；sRANKL 48 小时：89.21 比 36.95 比 36.94，p=0.004；sOPG 24 小时：207.71 比 69.39 比 111.91，p<0.001；sOPG 48 小时：143.36 比 69.38 比 111.91，p<0.001）。RA 患者在 48 小时时的 RANKL：OPG 比值明显更高（0.062 比 0.53 比 0.33，p<0.001）、hs-CRP（28.82 比 23.67 比 2.60，p<0.001）和 hs-TnI（0.90 比 0.76 比 0.012）。RA 患者的 GRACE 风险评分明显高于无 RA 的 ACS 患者（140.45 比 125.50，p=0.030），且与 exRANKL、RANKL：OPG、hs-CRP 和 hs-TnI 相关。我们的结果表明，与无 RA 的 ACS 患者相比，RA 合并 ACS 患者的 exRANKL、炎症标志物和死亡率风险更高。
