Mahdy Ahmed, Stradner Martin, Roessler Andreas, Brix Bianca, Lackner Angelika, Salon Adam, Goswami Nandu
Physiology Division, Otto Loewi Center of Research in Vascular Biology, Immunity and Inflammation, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
Rheumatology and Immunology Department, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
J Clin Med. 2021 Sep 9;10(18):4067. doi: 10.3390/jcm10184067.
The etiology of autoimmune rheumatic diseases is unknown. Endothelial dysfunction and premature atherosclerosis are commonly seen in these patients. Atherosclerosis is considered one of the main causes of cardiovascular diseases. Hypertension is considered the most important traditional cardiovascular risk. This case-control study aimed to investigate the relationship between autoimmune diseases and cardiovascular risk.
This study was carried out in patients with rheumatoid arthritis, RA ( = 10), primary Sjögren syndrome, PSS ( = 10), and healthy controls ( = 10). Mean blood pressure (MBP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse wave velocity (PWV, an indicator of arterial stiffness) were assessed via a Vicorder device. Asymmetric dimethylarginine (ADMA) was measured via ELISA. Retinal photos were taken via a CR-2 retinal camera, and retinal microvasculature analysis was carried out. T-tests were conducted to compare the disease and control groups. ANOVA and ANOVA-ANCOVA were also used for the correction of covariates.
A high prevalence of hypertension was seen in RA (80% of cases) and PSS (40% of cases) compared to controls (only 20% of cases). Significant changes were seen in MBP (RA 101 ± 11 mmHg; PSS 93 ± 10 mm Hg vs. controls 88 ± 7 mmHg, = 0.010), SBP (148 ± 16 mmHg in RA vs. 135 ± 16 mmHg in PSS vs. 128 ± 11 mmHg in control group; = 0.007), DBP (77 ± 8 mmHg in RA, 72 ± 8 mmHg in PSS vs. 67 ± 6 mmHg in control; = 0.010 in RA compared to the controls). Patients with PSS showed no significant difference as compared to controls (MBP: = 0.240, SBP: = 0.340, DBP: = 0.190). Increased plasma ADMA was seen in RA (0.45 ± 0.069 ng/mL) and PSS (0.43 ± 0.060 ng/mL) patients as compared to controls (0.38 ± 0.059 ng/mL). ADMA in RA vs. control was statistically significant ( = 0.022). However, no differences were seen in ADMA in PSS vs. controls. PWV and retinal microvasculature did not differ across the three groups.
The prevalence of hypertension in our cohort was very high. Similarly, signs of endothelial dysfunction were seen in autoimmune rheumatic diseases. As hypertension and endothelial dysfunction are important contributing risk factors for cardiovascular diseases, the association of hypertension and endothelial dysfunction should be monitored closely in autoimmune diseases.
自身免疫性风湿疾病的病因尚不清楚。这些患者中常见内皮功能障碍和动脉粥样硬化过早发生。动脉粥样硬化被认为是心血管疾病的主要原因之一。高血压被认为是最重要的传统心血管风险因素。本病例对照研究旨在调查自身免疫性疾病与心血管风险之间的关系。
本研究纳入类风湿关节炎（RA，n = 10）、原发性干燥综合征（PSS，n = 10）患者及健康对照者（n = 10）。通过Vicorder设备评估平均血压（MBP）、收缩压（SBP）、舒张压（DBP）和脉搏波速度（PWV，动脉僵硬度指标）。通过ELISA法检测不对称二甲基精氨酸（ADMA）。使用CR - 2视网膜相机拍摄视网膜照片，并进行视网膜微血管分析。采用t检验比较疾病组和对照组。方差分析（ANOVA）和协方差分析（ANOVA - ANCOVA）也用于校正协变量。
与对照组（仅20%的病例）相比，RA（80%的病例）和PSS（40%的病例）中高血压患病率较高。MBP（RA为101±11 mmHg；PSS为93±10 mmHg，对照组为88±7 mmHg，P = 0.010）、SBP（RA为148±16 mmHg，PSS为135±16 mmHg，对照组为128±11 mmHg；P = 0.007）、DBP（RA为77±8 mmHg，PSS为72±8 mmHg，对照组为67±6 mmHg；RA与对照组相比P = 0.010）有显著变化。PSS患者与对照组相比无显著差异（MBP：P = 0.240，SBP：P = 0.340，DBP：P = 0.190）。与对照组（0.38±0.059 ng/mL）相比，RA（0.45±0.069 ng/mL）和PSS（0.43±0.060 ng/mL）患者血浆ADMA升高。RA与对照组的ADMA差异有统计学意义（P = 0.022）。然而，PSS与对照组的ADMA无差异。三组间PWV和视网膜微血管无差异。
我们队列中高血压患病率很高。同样，自身免疫性风湿疾病中也存在内皮功能障碍迹象。由于高血压和内皮功能障碍是心血管疾病的重要危险因素，自身免疫性疾病中应密切监测高血压与内皮功能障碍的关联。
