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华西医学  2011 

类风湿关节炎患者发生动脉硬化的影响因素分析

, PP. 651-654

Keywords: 类风湿关节炎,颈动脉硬化

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Abstract:

【】 目的 采用高分辨率超声测定类风湿关节炎(rheumatoidarthritis,RA)患者颈动脉内中膜厚度和是否有斑块以及是否存在动脉硬化。 方法 分析2009年4月―2010年9月间150例RA患者的一般情况、发病情况、疾病活动性评分(DAS28评分),及实验室指标如血沉(ESR)、C反应蛋白(CRP)、抗环瓜氨酸抗体(ACCP)、类风湿因子(RF)、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白a及血尿酸的测定。采用颈动脉彩色多普勒超声测定RA患者与正常对照组120例颈动脉内中膜值及是否有斑块。 结果 150例RA患者20例出现动脉硬化,120例健康人群中3例出现动脉硬化,RA颈动脉内硬化危险因素单因素分析中,病程、DAS28评分、ApoA1、ApoB、HDL-C及尿酸与RA动脉硬化有关,而年龄、性别、ESR、CRP、RF、ACCP等与RA发生动脉硬化无关;RA动脉硬化多因素回归分析示病程、尿酸及高密度脂蛋白是RA发生动脉硬化的危险因素。 结论 颈动脉内中膜测定对RA动脉硬化具有一定临床价值。【Abstract】 Objective Todetectthecarotidarteryintima-mediathicknessandtheexistenceofcarotidplagueandarteriosclerosisbyhigh-resolutionultrasonographyinpatientswithrheumatoidarthritis(RA). Methods Atotalof150RApatientstreatedinourhospitalbetweenApril2009andSeptember2010wereincludedinthisstudy.Theirgeneralcondition,onsetofthediseaseanddiseaseactivityscore(DAS28scoring)wereanalyzed.Laboratoryindexeslikeerythrocytesedimentationrate(ESR),Creactiveprotein(CRP),Anti-cycliccitrullinatedpeptide(ACCP)antibody,rheumatoidfactor(RF),totalcholesterol(TC),triglycerides(TG),high-densitylipoproteincholesterol(HDL-C),low-densitylipoproteincholesterol(LDL-C),apolipoproteinA1(apoA1),apolipoproteinB(apoB),lipoprotein(a)(Lp(a)),anduricacid(UA)weremeasured.Carotidcolorultrasonographywasusedtodetectthecarotidintima-mediathicknessandtheexistenceofcarotidplaguein150patientswithRAand120patientsinthecontrolgroup. Results Twentyoutofthe150RApatientsandthreeoutofthe120controlsmanifestedarteriosclerosis.SinglefactoranalysisshowedacorrelationbetweenarteriosclerosisinRApatientsandcourseofdisease,DAS28scoring,ApoA,ApoB,HDL-C,andUA,andnocorrelationbetweenarteriosclerosisandage,gender,ESR,CRP,RF,andACCP.Multivariateregressionanalysisshowedthatthecourseofdisease,UAandHDL-CareindependentriskfactorsforarteriosclerosisinRApatients. Conclusion Analysisofthecarotidintima-mediahasacertainclinicalvalueinpredictingarteriosclerosisinRApatients.

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