中老年类风湿关节炎患者合并冠状动脉粥样硬化性心脏病的发病风险及相关因素研究

摘要

目的 探讨中老年类风湿关节炎(RA)患者合并冠状动脉粥样硬化性心脏病(CAD)的发病风险及相关因素.方法 回顾性分析2013年1月至2014年12月在首都医科大学附属北京安贞医院住院治疗的136例中老年RA患者的临床资料,其中合并CAD的76例中老年RA患者作为观察组,不合并CAD的中老年RA患者60例作为对照组.分别记录2组性别、年龄、RA病程、高血压、糖尿病、高脂血症、吸烟及服药情况,并记录患者体重指数、收缩压、舒张压、血清中三酰甘油、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、高敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy),比较2组患者各指标的差异.通过Logistic回归确定中老年RA患者合并CAD的预测因素.结果 观察组患者RA病程明显长于对照组,高血压比例明显高于对照组,糖皮质激素、硫酸羟氯喹(HCQ)使用率明显低于对照组,差异均有统计学意义[(15±9)年比(10±10)年、65.8％(50/76)比41.7％ (25/60)、23.7％ (18/76)比46.7％ (28/60)、5.3％ (4/76)比23.3％ (14/60),均P＜0.01];观察组患者血清总胆固醇、HDL-C、LDL-C水平低于对照组,Hcy水平高于对照组,差异均有统计学意义[(4.2±1.0) mmol/L比(4.8±0.9) mmol/L、(1.06±0.30) mmol/L比(1.20±0.33) mmol/L、(2.5±0.8) mmol/L比(2.9±0.8) mmol/L、(17±8)μmol/L比(14±7)μmol/L,P＜0.01或P＜0.05].经Logistic回归分析发现RA病程长、合并高血压是中老年RA患者合并CAD的独立危险因素[比值比分别为1.054、2.629,95％置信区间分别为1.009 ～1.101、1.201 ～ 5.755),使用HCQ是其保护因素(比值比为0.118,95％置信区间:0.029～0.484).结论 RA病程长、合并高血压是中老年RA患者合并CAD的独立危险因素,使用HCQ是其保护因素.中老年RA患者应积极纠正体内免疫紊乱状态,对降低心血管不良事件的发生具有极其重要的意义.%Objective To investigate the relative factors of coronary artery disease (CAD) in middle-aged and elderly patients with rheumatoid arthritis (RA).Methods Clinical data of 136 middle-aged and elderly patients with RA from January 2013 to December 2014,including 76 cases with CAD (observation group) and 60 cases without CAD (control group),were analyzed retrospectively.The gender,age,cause of RA,hypertension,diabetes mellitus,dyslipidemia,smoking and medications were recorded;the body mass index (BMI),systolic blood pressure (SBP) and diastolic blood pressure (DBP),the serum levels of triglyceride,total cholesterol,high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),fasting blood glucose (FBG),high-sensitive C-reactive protein (hs-CRP) and homocysteine (Hcy) were detected.Above indexes were compared between groups,and multivariate Logistic regression analysis was performed to aaalyze the independent predictors of CAD in middle-aged and elderly patients with RA.Results The course of RA was significantly longer,the proportion of hypertension was significantly higher,the usage rates of glucocorticoid hormone and hydroxychloroquine (HCQ) were significantly lower in observation group than those in control group [(15 ± 9) years vs (10±10) years,65.8％ (50/76)vs41.7％ (25/60),23.7％ (18/76)vs46.7％ (28/60),5.3％ (4/76)vs 23.3％ (14/60),P ＜ 0.01].The serum levels of total cholesterol,LDL-C,HDL-C was significantly lower,the level of Hcy was significantly higher in observation group than those in control group [(4.2 ± 1.0) mmol/L vs (4.8±0.9) mmol/L,(2.5 ±0.8) mmol/L vs (2.9±0.8) mmol/L,(1.06±0.30) mmol/L vs (1.20± 0.33) mmol/L,(17 ±8) μmol/L vs (14 ±7) μmol/L] (P ＜0.01 or P ＜0.05).Logistic regression analysis showed that the cause of RA and hypertension were independent risk factors of CAD,the usage of HCQ was a protective factor of CAD in middle-aged and elderly patients with RA [odds ratio:1.054,2.629,0.118;95％ confidence interval:1.009-1.101,1.201-5.755,0.029-0.484].Conclusions Longer cause of RA and hypertension are independent risk factors of CAD,HCQ usage is a protective factor of CAD in middle-aged and elderly patients with RA;actively correcting the immune disorder is of great importance for preventing cardiovascular adverse events in middle-aged and elderly patients with RA.