Incidence Rate of Arteriosclerosis in Patients with Rheumatoid Arthritis_West China Medical Journal

Authors：

DONG Jianling ¹ ,  YANG Jing ¹ , ZHANG HaiFeng ² , ZOU Jinmei ¹ , ZHANG Yu ¹ , TIAN Lan ¹

1. Department of Rheumatology, 2. Department of Physical Diagnosis, Central Hospital of Mianyang, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

YANG Jing, Email: dong1980565@163.com

Keywords：

类风湿关节炎; 颈动脉硬化

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【摘要】　目的　采用高分辨率超声测定类风湿关节炎（rheumatoid arthritis，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　 To detect the carotid artery intima-media thickness and the existence of carotid plague and arteriosclerosis by high-resolution ultrasonography in patients with rheumatoid arthritis (RA). 　Methods　 A total of 150 RA patients treated in our hospital between April 2009 and September 2010 were included in this study. Their general condition, onset of the disease and disease activity score (DAS28 scoring) were analyzed. Laboratory indexes like erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Anti-cyclic citrullinated peptide (ACCP) antibody, rheumatoid factor (RF), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apo A1), apolipoprotein B (apo B), lipoprotein(a) (Lp(a)), and uric acid (UA) were measured. Carotid color ultrasonography was used to detect the carotid intima-media thickness and the existence of carotid plague in 150 patients with RA and 120 patients in the control group. 　Results　 Twenty out of the 150 RA patients and three out of the 120 controls manifested arteriosclerosis. Single factor analysis showed a correlation between arteriosclerosis in RA patients and course of disease, DAS28 scoring, Apo A, Apo B, HDL-C, and UA, and no correlation between arteriosclerosis and age, gender, ESR, CRP, RF, and ACCP. Multivariate regression analysis showed that the course of disease, UA and HDL-C are independent risk factors for arteriosclerosis in RA patients. 　Conclusion　 Analysis of the carotid intima-media has a certain clinical value in predicting arteriosclerosis in RA patients.

Citation： DONG Jianling,YANG Jing,ZHANG HaiFeng,ZOU Jinmei,ZHANG Yu,TIAN Lan. Incidence Rate of Arteriosclerosis in Patients with Rheumatoid Arthritis. West China Medical Journal, 2011, 26(5): 651-654. doi: Copy

1.	Myllykangas-luosujrvi R, Aho K, Kautiainten H, et al. Shortening of life span and causes of excess mortality in a populationbasedseries of subjects with rheumatoid arthritis[J]. Clin Exp Rheumatol, 1995, 13(2): 149-153.
2.	Bacon PA, Stevens RJ, Carruthers DM, et al. Accelerated atherogenesisin autoimmune rheumatic diseases[J]. Autoimmun Rev, 2002, 1(6): 338-347.
3.	Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31(3): 315-324.
4.	张梅, 张运, 高月花, 等. 颈动脉及股动脉内膜中层厚度正常值的对比研究[J].中国医学影像技术, 2002, 18(1): 32-33.
5.	Salonen R, Nyyssonen K, Porkkla E, et al. Kuopio Atherosclerosis Prevention Study(KAPS). A population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and fermoral arteries[J].Circulation, 1995, 92(7): 1758-1764.
6.	Sattar N, McCarey DW, Capell H, et al. Explaining how "high grade" systemin infla-mmation accelerates vascular risk in rheumatoidarthritis[J]. Circulation, 2003, 108(24): 2957-2963.
7.	Panoulasl VF, Milionis HJ, Douglas KM, et al. Association of serum uric acid with cardiovascular disease in rheumatoid arthritis[J]. Rheumatology, 2007, 46(9): 1466-1470.
8.	van Halm VP, Nielen MM, Nurmohamed MT, et al. Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis[J]. Ann Rheum Dis, 2007, 66(2): 184-188.
9.	Walldius G, Jungner I. The apoB/apoA-I ratio: a strong new risk factor for cardiovascular disease and a target for lipid-lowering therapy-a review of the evidence[J]. J Intern Med, 2006, 259(5): 493-519.
10.	Luc G, Bard JM, Ferrières J, et al. Value of HDL cholesterol apolipoprotein A-I lipoprotein A-I and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study Prospective Epidemiological Study of Myocardial Infarction[J]. Arterioscler Thromb Vasc Biol, 2002, 22(7): 1155-1161.
11.	Walldius G, Jungner I, Holme I, et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study[J]. Lancet, 2001, 358(9298): 2026-2033.
12.	Sharrett AR, Ballantyne CM, Coady SA, et al. Coronary heart disease prediction from lipoprotein cholesterol levels,triglycerides, lipoprotein(a),apolipoproteins A-I and B, and HDL density subfractions: the Atherosclerosis Risk in Communities (ARIC) Study[J]. Circulation, 2001, 104(10): 1108-1113.
13.	Sharett AR, Patsch VV, Sorlie PD, et al. Associations of lipoprotein cholesterols, apolipoproteins A-I and B, and triglycerides with carotid atherosclerosis and coronary heart disease. The Atherosclerosis Risk in Communities (ARIC) Study[J]. Arterioscler Thromb, 1994, 14 (7): 1098-1104.
14.	Steer P, Millgård J, Sarabi DM, et al. Cardiac and vascular structure and function are related to lipid peroxidation and metabolism [J]. Lipids, 2002, 37(3): 231-236.
15.	Keulen ET, Kruijshoop M, Schaper NC, et al. Increased intima-media thickness in familia combined hyperlipidemia associated with apolipoprotein B[J]. Arterioscler Thromb Vasc Biol, 2002, 22(2): 283-288.

1. 　Myllykangas-luosujrvi R, Aho K, Kautiainten H, et al. Shortening of life span and causes of excess mortality in a populationbasedseries of subjects with rheumatoid arthritis[J]. Clin Exp Rheumatol, 1995, 13(2): 149-153.
2. 　Bacon PA, Stevens RJ, Carruthers DM, et al. Accelerated atherogenesisin autoimmune rheumatic diseases[J]. Autoimmun Rev, 2002, 1(6): 338-347.
3. 　Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31(3): 315-324.
4. 　张梅, 张运, 高月花, 等. 颈动脉及股动脉内膜中层厚度正常值的对比研究[J].中国医学影像技术, 2002, 18(1): 32-33.
5. 　Salonen R, Nyyssonen K, Porkkla E, et al. Kuopio Atherosclerosis Prevention Study(KAPS). A population-based primary preventive trial of the effect of LDL lowering on atherosclerotic progression in carotid and fermoral arteries[J].Circulation, 1995, 92(7): 1758-1764.
6. 　Sattar N, McCarey DW, Capell H, et al. Explaining how "high grade" systemin infla-mmation accelerates vascular risk in rheumatoidarthritis[J]. Circulation, 2003, 108(24): 2957-2963.
7. 　Panoulasl VF, Milionis HJ, Douglas KM, et al. Association of serum uric acid with cardiovascular disease in rheumatoid arthritis[J]. Rheumatology, 2007, 46(9): 1466-1470.
8. 　van Halm VP, Nielen MM, Nurmohamed MT, et al. Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis[J]. Ann Rheum Dis, 2007, 66(2): 184-188.
9. 　Walldius G, Jungner I. The apoB/apoA-I ratio: a strong new risk factor for cardiovascular disease and a target for lipid-lowering therapy-a review of the evidence[J]. J Intern Med, 2006, 259(5): 493-519.
10. 　Luc G, Bard JM, Ferrières J, et al. Value of HDL cholesterol apolipoprotein A-I lipoprotein A-I and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study Prospective Epidemiological Study of Myocardial Infarction[J]. Arterioscler Thromb Vasc Biol, 2002, 22(7): 1155-1161.
11. 　Walldius G, Jungner I, Holme I, et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study[J]. Lancet, 2001, 358(9298): 2026-2033.
12. 　Sharrett AR, Ballantyne CM, Coady SA, et al. Coronary heart disease prediction from lipoprotein cholesterol levels,triglycerides, lipoprotein(a),apolipoproteins A-I and B, and HDL density subfractions: the Atherosclerosis Risk in Communities (ARIC) Study[J]. Circulation, 2001, 104(10): 1108-1113.
13. 　Sharett AR, Patsch VV, Sorlie PD, et al. Associations of lipoprotein cholesterols, apolipoproteins A-I and B, and triglycerides with carotid atherosclerosis and coronary heart disease. The Atherosclerosis Risk in Communities (ARIC) Study[J]. Arterioscler Thromb, 1994, 14 (7): 1098-1104.
14. 　Steer P, Millgård J, Sarabi DM, et al. Cardiac and vascular structure and function are related to lipid peroxidation and metabolism [J]. Lipids, 2002, 37(3): 231-236.
15. 　Keulen ET, Kruijshoop M, Schaper NC, et al. Increased intima-media thickness in familia combined hyperlipidemia associated with apolipoprotein B[J]. Arterioscler Thromb Vasc Biol, 2002, 22(2): 283-288.

West China Medical Journal

Incidence Rate of Arteriosclerosis in Patients with Rheumatoid Arthritis

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