慢作用抗风湿药对类风湿关节炎患者血脂的影响

摘要

目的 探讨类风湿关节炎患者抗风湿治疗对血脂及疾病活动相关指标的影响. 方法 选择在我院治疗的符合1987年美国风湿病学会诊断标准的类风湿关节炎患者82例,联合应用慢作用药甲氨蝶呤、柳氮磺胺吡啶、硫酸羟氯喹治疗,以健康体检者79例作为对照.分别测定健康对照组、类风湿关节炎组治疗前及治疗后12个月的疾病活动分数(DAS28)、血沉、C-反应蛋白、血脂.结果类风湿关节炎患者血胆崮醇、低密度脂蛋白胆固醇、三酰甘油治疗前较对照组高(均P<0.01);高密度脂蛋白治疗前较对照组低(P<0.01);治疗12个月后,类风湿关节炎患者疾病活动分数、血沉、C-反应蛋白与治疗前比较明显降低[(6.7±0.6)与(2.1±0.9)、(62±18)mm/h与(13±9)mm/h、(2.2±0.3)mg/L与(0.3±0.2)mg/L,均P<0.01];血高密度脂蛋白与治疗前比较明显增高,分别为(1.0±0.1)mmol/L与(1.5±0.3)mmol/L(P<0.01). 结论 病情活动的类风湿关节炎患者血脂水平异常,控制炎症过程的药物,使疾病活动分数、血沉或C-反应蛋白下降的同时,导致血清高密度脂蛋白的水平升高,可能使类风湿关节炎患者动脉粥样硬化及心血管事件的风险降低.%Objective To investigate the effect of slow-acting antirheumatic drugs on lipid profile and disease activity index in patients with rheumatoid arthritis (RA). Methods Eighty-two patients with RA who met the American College of Rheumatology (ACR) criteria were treated with disease-modifying antirheumatic drugs including methopterin (MTX), salazosulfapyridine (SASP) and hydroxychloroquine sulfate, while seventy-nine healthy volunteers were used for control. All persons were followed up for 12 months. The observations included 28 joint indices score (DAS-28), lipid profile, c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results Compared with the control group before treatment, RA patients exhibited higher serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides. Whereas, high-density lipoprotein cholesterol (HDL-C) was significantly lower. After 12 months treatment, the disease activity index[(6.7±0.6)vs. (2.1±0.9)], ESR [(62±18)mm/h vs. (13±9)mm/h] and CRP [(2.2±0.3 ) mg/L vs. (0. 3±0.2 ) mg/L, all P<0.01] were significantly decreased and HDL-C [1.0±0. 1)mmol/L vs. (1.5±0. 3)mmol/L, P<0. 01] was increased in RA patients. Conclusions RA patients are characterized by an atherogenic lipid profile, which are improved after therapy. Immuno-intervention to control disease activity may reduce the risks for the atherosclerotic process and cardiovascular events in RA patients.