Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
RMD Open. 2022 Jul;8(2). doi: 10.1136/rmdopen-2022-002270.
The aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima-media thickness (cIMT) and Ankle Brachial Index (ABI)) and to determine the predictive factors of theses parameters.
This was a case control study conducted over 12 months including 47 patients with SpA-free-cardiovascular (CV) disease in comparison with age and sex matched 47 healthy controls. Sociodemographic, clinical and biological features as well as therapeutic modalities were recorded in our patients. All subjects had Doppler ultrasound with measurement of cIMT, FMD and ABI. Ultrasound measurements were compared between patients and controls. Linear regression was performed and assessed by machine learning to determine the predictive models of markers of subclinical atherosclerosis.
We found higher cIMT (p<0.0001), lower FMD (p=0.008) and higher left ABI (0.048) in patients with SpA compared with controls. cIMT was positively correlated to patient-related parameters (age, systolic blood pressure) and disease parameters (age at onset of SpA, disease duration and renal involvement). Biologically, cIMT was positively correlated with creatinine, blood-glocose, total cholesterol (CT) and CT/cholesterol-high density lipoprotein ratio. FMD was negatively correlated with male gender, age, systolic blood pressure, creatinine, blood glucose and Left Lequesne Index. ABI was significantly associated with diastolic blood pressure. Multiple regression analysis identified age, CT and creatinine as independents predictive factors for increased cIMT. Regarding endothelial dysfunction, blood glucose and Left Lequesne Index were the independents predictive factors of decreased FMD.
Our study supported the accelerated subclinical atherosclerosis in patients with SpA. This subclinical atherosclerosis was mainly mediated by traditional CV risk factors.
我们的研究目的是通过结合三种超声方法（血流介导扩张（FMD）、颈动脉内膜中层厚度（cIMT）和踝臂指数（ABI））评估脊柱关节炎（SpA）中的亚临床动脉粥样硬化，并确定这些参数的预测因素。
这是一项为期 12 个月的病例对照研究，纳入了 47 例无心血管（CV）疾病的 SpA 患者，并与年龄和性别匹配的 47 名健康对照进行比较。记录了患者的社会人口统计学、临床和生物学特征以及治疗方式。所有受试者均接受多普勒超声检查，测量 cIMT、FMD 和 ABI。比较患者和对照组的超声测量值。进行线性回归并通过机器学习进行评估，以确定亚临床动脉粥样硬化标志物的预测模型。
我们发现 SpA 患者的 cIMT（p<0.0001）、FMD（p=0.008）和左 ABI（0.048）均高于对照组。cIMT 与患者相关参数（年龄、收缩压）和疾病参数（SpA 发病年龄、疾病持续时间和肾脏受累）呈正相关。生物学上，cIMT 与肌酐、血糖、总胆固醇（CT）和 CT/胆固醇-高密度脂蛋白比值呈正相关。FMD 与性别、年龄、收缩压、肌酐、血糖和左 Lequesne 指数呈负相关。ABI 与舒张压显著相关。多元回归分析确定年龄、CT 和肌酐是 cIMT 增加的独立预测因素。关于内皮功能障碍，血糖和左 Lequesne 指数是 FMD 降低的独立预测因素。
我们的研究支持 SpA 患者亚临床动脉粥样硬化的加速发展。这种亚临床动脉粥样硬化主要由传统的心血管危险因素介导。
