| 摘要: |
| 目的 探讨近10年类风湿关节炎（RA）合并冠状动脉粥样硬化性心脏病（CHD）的患病趋势和影响因素。方法 选择2009年1月1日至2019年3月20日天津市第一中心医院就诊的RA患者5 426例，选择同期就诊的骨关节炎（OA）患者1 483例作为对照。收集并比较RA及OA患者的基本信息、实验室指标、CHD及其相关并发症的发生情况和药物使用情况。采用logistic回归模型分析RA患者合并CHD的影响因素。结果 男性、女性RA患者CHD患病率［32.1%（321/1 000）vs 32.3%（323/1 000）］差异无统计学意义（χ2=0.02，P=0.90）。近10年RA患者CHD、高脂血症、高血压的患病率随时间均有所上升（χ2=115.67、129.41、193.81，P均<0.01），而糖尿病患病率在2014年之后有所下降（χ2=29.99，P<0.01）。以年龄和性别按1：1进行倾向评分匹配后，RA患者与OA患者CHD患病率差异无统计学意义（P=0.74）；RA患者红细胞沉降率（ESR）、CRP、白细胞介素2受体（IL-2R）、IL-6、高密度脂蛋白胆固醇（HDL-C）、类风湿因子（RF）、抗环瓜氨酸肽（ACCP）、D-二聚体、纤维蛋白原（FiB）、心肌型肌酸激酶同工酶（CK-MB）水平和抗角蛋白抗体（AKA）阳性率均高于OA患者，肌酸激酶、血糖水平均低于OA患者，差异均有统计学意义（P均<0.05）。合并CHD的RA患者的ESR、CRP、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、三酰甘油、免疫球蛋白G型类风湿因子（IgG-RF）、ACCP、FiB、血糖、尿酸水平和AKA阳性率均高于未合并CHD的RA患者，而HDL-C、IgG、IgM、25-羟基维生素D［25-（OH）D］水平均低于未合并CHD的RA患者，差异均有统计学意义（P均<0.05）。Logistic回归分析结果显示，RA患者CHD患病率与总胆固醇、ACCP、IgG、25-（OH）D水平呈负相关，与IgG-RF、尿酸水平呈正相关（P均<0.05）。结论 临床治疗中应重视RA患者CHD危险因素，以选择更具针对性、更有效的RA治疗方式，从而降低CHD患病风险，提高患者生活质量。 |
| 关键词: 类风湿关节炎 冠心病 患病率 骨关节炎 胆固醇 |
| DOI：10.16781/j.0258-879x.2020.10.1068 |
| 投稿时间：2019-12-20修订日期：2020-02-05 |
| 基金项目:天津市科技计划项目（16ZXMJSY00220）． |
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| Prevalence of coronary atherosclerotic heart disease in patients with rheumatoid arthritis and its influencing factors: a 10-year cross-sectional study |
| WANG Chang-lei1,KONG Chun-yu2,QI Wu-fang2* |
(1. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 300110, China;
2. Department of Rheumatology and Immunology, Tianjin First Central Hospital, Tianjin 300110, China
*Corresponding author) |
| Abstract: |
| Objective To explore the prevalence and influencing factors of coronary atherosclerotic heart disease (CHD) in rheumatoid arthritis (RA) patients during past 10 years. Methods A total of 5 426 RA patients were selected from Jan. 1, 2009 to Mar. 20, 2019 in the Tianjin First Central Hospital, and 1 483 osteoarthritis (OA) patients were selected as controls. Basic information, laboratory indicators, prevalence of CHD and related complications, and drug use of RA and OA patients were collected and compared. The influencing factors of CHD prevalence in RA patients were analyzed by logistic regression. Results There was no significant difference in the prevalence of CHD between male and female RA patients (32.1%, 321/1 000 vs 32.3%, 323/1 000; χ2=0.02, P=0.90). The prevalence rates of CHD, hyperlipidemia and hypertension in RA patients were significantly increased in the past 10 years (χ2=115.67, 129.41, 193.81, all P<0.01), while the prevalence of diabetes mellitus was significantly decreased after 2014 (χ2=29.99, P<0.01). After propensity score matching of 1:1 by age and gender, there was no significant difference in CHD prevalence between the RA and OA patients (P=0.74). The levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 2 receptor (IL-2R), interleukin 6 (IL-6), high density lipoprotein-cholesterol (HDL-C), rheumatoid factor (RF), anti-cyclic citrullinated peptide (ACCP), D-dimer, fibrinogen (FiB) and creatine kinase-myocardial band (CK-MB), and positive rate of anti-keratin antibody (AKA) were significantly higher in the RA patients than those in the OA patients, while the levels of creatine kinase (CK) and blood glucose were significantly lower than those in the OA patients (all P<0.05). The levels of ESR, CRP, total cholesterol, low density lipoprotein-cholesterol (LDL-C), triglyceride, immunoglobulin G-rheumatoid factor (IgG-RF), ACCP, FiB, blood glucose and uric acid, and the positive rate of AKA were all significantly higher in the RA patients with CHD than those in the RA patients without CHD, while the levels of HDL-C, immunoglobulin G (IgG), immunoglobulin M (IgM) and 25-hydroxyvitamin D were significantly lower than those in the RA patients without CHD (all P<0.05). Logistic regression analysis showed that the prevalence of CHD was negatively correlated with the levels of total cholesterol, ACCP, IgG and 25-hydroxyvitamin D, but positively correlated with the levels of IgG-RF and uric acid in PA patients (all P<0.05). Conclusion In clinical treatment, we should pay more attention to the risk factors of CHD in RA patients so as to select more targeted and effective RA treatment, reducing the risk of CHD and improving the quality of life of patients. |
| Key words: rheumatoid arthritis coronary disease prevalence osteoarthritis cholesterol |
