类风湿关节炎患者合并心脑血管病的危险性分析

目的分析类风湿关节炎（RA）患者的心脑血管病（CCVD）发病率和发病情况;探讨RA患者合并CCVD的危险因素。方法回顾性分析了568例RA患者的一般情况、发病情况、实验室检查、治疗方案以及治疗反应（欧洲抗风湿联盟EULAR反应标准）,以及CCVD患病情况和传统危险因素;分析了RA合并CCVD的危险因素。结果（1）RA合并CCVD共92例（16．20％）。包括冠状动脉粥样硬化性心脏病49例,占53．26％;脑血管疾病21例。占22．83％;高血压性心脏病合并冠心病12例。占13．04％,其中2例合并心力衰竭;彩色多普勒提示大-中动脉粥样硬化斑块形成6例。占6．52％;肢端坏疽4例（4．34％）。（2）RA是否合并CCVD与DAS28病情活动性评分、血小板计数、C反应蛋白（CRP）水平和关节外脏器受累数有关（分别P〈0．001。OR=9．67;P〈0．015,OR=6．91;P〈0．003,OR=1．35;P〈0．015,OR=2．14）。与传统CCVD危险因素及其数目无关。（3）CCVD发生与治疗反应、是否进行有效的危险因素干预、长期应用Cox-2选择性的非甾体类抗风湿药和较大剂量糖皮质激素治疗相关（分别P=0．006,RR=2．31;P〈0．001．RR=5．90;P〈0．001,RR=2．63;P=0．013,RR=1．34）。结论RA患者CCVD发生率高,RA病情活动、高炎性反应状态、关节外脏器受累、治疗反应差、长期使用较大剂量糖皮质激素和选择性环氧化酶-2（Cox-2）抑制剂和没有有效的传统危险因素干预是RA合并CCVD的危险因素。

Risk factor assessment of cardiocerebrovascular diseases in patients with rheumatoid arthritis

Objective To assess the prevalence of cardiocerebrovascular diseases ( CCVDs) in the patients with rheumatoid arthritis (RA) and analyzed the risk factors. Methods The clinical data of 568 RA patients hospitalized 1995-2005, were analyzed retrospectively. Results ( 1 ) The total prevalence of CCVD was 16. 2% (92/568). The prevalence rate of coronary heart disease , cerebrovascular disease, hypertensive heart disease together with coronary heart disease including 2 cases of heart failure, atherogenesis in large and medium-size arteries proved by color Doppler ultrasonic examination, and gangrene of extremities were 53.26% (49/92) , 22. 83% (21/92), 13.04% (12/92), 6. 52% (6/92), and 4. 34% (4/92 ) respectively. ( 2) Complication of CCVD in RA patients was associated with age, DAS28 disease activity score, number of involved extra-articular organs, platelet count, hyperfibrinogenemia, and C-reactive protein; and was not associated with sex, auto-antibody, hereditary factor, other traditional CCBVD risk factors, and the number of risk factors. (3) The occurrence of CCVD in RA patients was significantly correlated with poor therapeutic response, lack of persistent effective prevention of the traditional risk factors, use of cyclooxygenase ( Cox) -2 specific inhibitors, and long-term medication of high-dosage glucocorticoid. Conclusion Activity of the disease of RA, high inflammatory index, extra-articular involvement, poor response to treatment, lack of persistent effective prevention of the traditional risk factors, use of Cox-2 specific inhibitor, and long-term medication of high-dosage glucocorticoid are risk factors of CCVD-co-morbidities in RA pate