全国多中心类风湿关节炎冠心病危险因素的现况调查

摘要

目的:了解我国类风湿关节炎( rheumatoid arthritis,RA)患者冠心病(coronary artery disease,CAD)的患病情况并评估其发生的危险因素.方法:调查RA患者冠心病相关的临床资料,包括冠心病的患病情况、冠心病传统危险因素[糖尿病、高血压、高血脂、吸烟及体重指数(BMI)]及RA临床表现[关节肿胀、疼痛、畸形数目,皮下结节数目,动态红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、类风湿因子( rheumatoid factor,RF)等]、关节功能状态评分及用药情况.对冠心病组及非冠心病组的危险因素、临床特点及用药情况等方面进行单因素比较及多因素Logistic回归分析.结果:共调查21家医院的960例RA患者,其中女性779人,男性181人,女∶男=4.3∶1,平均年龄(52.7±13.9)岁(11.0～86.0岁).RA患者冠心病的患病率为3.5％( 34/960),其中合并超重和肥胖者占35.1％(377/960)、吸烟者占12.3％(118/960)、高血压者占17.0％( 163/960)、糖尿病者占7.7％(74/960)、高胆固醇血症者占0.4％ (4/960)、脑血管病者占3.0％(29/960).冠心病组与非冠心病组相比,年龄高[(64.7±9.3)岁vs.(52.3±14.0)岁,P＜0.001]、皮下结节数目多(14.7％vs.3.1％,P =0.005)、肺间质病变发生率高(17.6％vs7.0％,P=0.034)、羟氯喹(hydroxychloroquine,HCQ)使用比例低(5.9％vs.22.6％,P=0.021)、糖尿病及高血压患病率高(29.4％vs.7.0％,P＜0.001；38.2％vs.16.2％,P=0.001),而受检时关节畸形数目、RF水平及糖皮质激素的使用、高胆固醇血症患病率及BMI与冠心病发生无关.经多元Logistic回归分析,高龄、合并糖尿病及高血压为RA合并冠心病的独立危险因素,使用HCQ为RA合并冠心病的保护因素.结论:RA患者冠心病的患病率为3.5％.高龄、合并糖尿病及高血压为其独立危险因素,合并使用HCQ为其保护因素.%Objective;To learn about the prevalence and risk factors of coronary artery disease (CAD) in rheumatoid arthritis ( RA). Methods; Data were obtained from a 12-month retrospective investigation of the patients with RA, randomly selected from Departments of Rheumatology and Immunology in 21 big hospitals in China. The data were collected about their social conditions, clinical conditions, medications associated with RA, such as disease modifying anti-rheumatic drugs (DMARDs), non steroidal anti-inflammatory drugs (NSAIDs), glucocorticoid, biologic agents. A nonparameter test and multivariate logistic regression analysis were performed. Results; In the study, 960 patients were enrolled. The prevalence of CAD was 3. 5% in China, which was obviously higher than that of normal people. The prevalence of overweight and obesity, smoking, hypertension, diabetes mellitus, hypercholesterolemia and cerebrovascular disease were 35. 1% , 12.3% , 17.0% , 7.7% , 0.4% and 3.0% , respectively. Compared with the control group, the CAD group had higher age [ (64. 7 ?.3) years t? (52. 3 ?14. 0 ) years,P <0.001 ] , more rheumatoid nodules (14. 7% vs. 3. 1% ,P =0. 005) , lower rate of hydroxy-chloroquine ( HCQ) use (5. 9% vs. 22.6% ,P =0.021) , higher prevalence rates of lung interstitial disease (17.5% 玸. 7. 0% , P < 0.001 ) , diabetes mellitus and hypertension (29. 4% vs. 7. 0% , P < 0.001; 38. 2% vs. 16. 2% ,P =0.001). There was no obvious correlation of CAD in RA with joint deformity , rheumatoid factor ( RF) titer, glucocorticoid use, hypercholesterolemia and body mass index (BMI). Multivariate analysis showed higher age, diabetes mellitus and hypertension were independent predictors of CAD, and the use of HCQ was a protective factor of CAD. Conclusion; The prevalence of CAD is 3.5%. Higher age, diabetes mellitus and hypertension are independent predictors of CAD, and the use of HCQ is a protective factor of CAD.