炎症及免疫指标对类风湿关节炎患者血脂的影响分析

目的 探讨类风湿关节炎(RA)患者血脂情况以及炎症和免疫状态对血脂的影响.方法 选取2008年至2009年在我院住院的225例RA患者,检测入院第1天的血脂、血沉(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽抗体(抗CCP)、抗角蛋白抗体(AKA)、抗核周因子抗体(APF)、补体(C),分析上述指标对血脂及致动脉粥样硬化指数(AIP)的影响.结果 (1)225例患者中,12.9％的患者总胆固醇(TC)升高,43.6％的患者高密度脂蛋白胆固醇(HDL-C)降低,10.2％的患者低密度脂蛋白胆固醇(LDL-C)升高,14.2％的患者TG升高.(2) TC升高组中C3高于TC正常组(P＜0.05),HDL-C降低组的ESR及CRP高于HDL-C正常组(P＜0.05),LDL-C升高组CRP、C3及C4高于LDL-C正常组(P＜0.05).(3)多因素逐步回归分析显示:C3与TC水平正相关(R2=0.067,P＜0.05),ESR、CRP与HDL-C水平负相关(R2=0.202,P＜0.05),CRP、抗CCP抗体与LDLC正相关(R2=0.129,P＜0.05),ESR、C4与AIP正相关(R2=0.046,P＜0.05).结论 类风湿关节炎患者的系统性炎症及异常免疫反应影响其血脂水平及血脂的致动脉粥样硬化作用.

Association between systemic inflammation and autoimmunity parameters and plasma lipid in patients with rheumatoid arthritis

Objective The purpose of this study was to observe the association between inflammation status/autoimmune antibodies and plasma lipid in patients with rheumatoid arthritis (RA).Methods A total of 402 RA patients were admitted into our hospital during January 2008 to March 2009 and 225 RA patients who met the inclusion criteria were selected to perform a full lipid profile examination including total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG).Erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),rheumatoid factor (RF),anti-cyclic citrullinated peptide (anti-CCP),anti-keratin antibody (AKA),anti-perinuclear factor autoantibody (APF) and complement (C) were also evaluated.Atherogenic index of plasma (AIP) was calculate by the formula Log(TG/HDL-C).Results ( 1 ) There were 12.9％,10.2％ and 14.2 ％ patients with elevated TC,LDL-C and TC respectively,patients with reduced HDL-C accounted for 43.6％.( 2 ) C3 was higher in elevated TC group than normal TC group ( P ＜ 0.05 ).ESR and CRP were significantly higher in decreased HDL-C group than in normal HDL-C group (P ＜ 0.05 ).CRP,C3 and C4 were significantly higher in elevated LDL-C group than in normal LDL-C group ( P ＜ 0.05).(3)Multiple stepwise regression analysis showed that C3 was positively correlated with TC ( R2 =0.067,P ＜0.05 ).Both ESR and CRP were negative correlated with HDL-C (R2 =0.202,P ＜ 0.05).CRP and antiCCP were positively correlated with LDL-C (R2 =0.129,P ＜0.05).ESR and C4 were positively correlated with AIP ( R2 =0.046,P ＜ 0.05 ).Conclusion This study showed that rheumatoid arthritis is associated with an abnormal lipid profile,especially in patients with increased inflammation markers and autoimmune antibodies.Moreover,ESR and C4 were predictors of increased AIP in this cohort.