类风湿关节炎患者NGAL、Lp-PLA2及血脂异常对动脉粥样硬化的预测及在转归中的价值

目的探讨类风湿关节炎(RA)患者中性粒细胞明胶酶相关载脂蛋白(NGAL)、脂蛋白相关磷脂酶(Lp-PLA)2及血脂异常对动脉粥样硬化(AS)的预测及转归中的价值分析。方法选择RA患者100例(缓解期48例和活动期52例)、健康人50例作为对照组。采用动脉彩色多普勒超声诊断仪进行AS检查,比较两组AS患病率及总动脉内中膜厚度(IMT)值;计算血浆致动脉粥样硬化指数(AIP);日立7600全自动生化分析仪测定各组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);采用半自动免疫比浊法检测血清NGAL、Lp-PLA2水平差异;采用Spearman相关分析指标的关系,采用Logistic回归分析RA合并AS的危险因素。结果与对照组相比,RA患者体内TC、TG、LDL-C、NGAL、Lp-PLA2含量显著升高,斑块面积、斑块厚度和IMT数值显著升高,HDL-C含量显著降低(P<0.05)。与RA缓解期患者相比,RA活动期患者体内NGAL、Lp-PLA2含量,斑块面积、斑块厚度和IMT数值显著升高(P<0.05)。RA组中合并AS患者为41例(死亡组15例,非死亡组26例),RA无AS患者59例。与对照组和RA无AS组相比,RA合并AS组TC、TG、LDL-C含量显著升高,斑块面积、斑块厚度和IMT数值显著升高,HDL-C含量显著降低(P<0.05)。与AS非死亡组相比,AS死亡组TC、TG、LDL-C含量显著升高,斑块面积、斑块厚度和IMT数值显著升高,HDL-C含量显著降低(P<0.05)。RA患者体内TC、TG和LDL-C含量、NGAL、Lp-PLA2含量与患者的疾病程度(活动期、缓解期)、是否合并AS、疾病结局(生存、死亡)、斑块面积、斑块厚度和IMT数值呈明显正相关(P<0.05)。RA患者HDL-C含量与患者的疾病程度(活动期、缓解期)、是否合并AS、疾病结局(生存、死亡)、斑块面积、斑块厚度和IMT数值呈明显负相关(P<0.05)。Logistic回归分析结果显示,RA患者体内TC、TG和LDL-C含量、NGAL、Lp-PLA2含量与患者是否合并AS及生存结局密切相关,是其主要的独立危险因素(P<0.05)。结论RA患者血清NGAL、Lp-PLA2水平升高且血脂异常,对RA患者并发AS的病理过程起到预判作用,利于早期发现RA患者出现AS。

Value of NGAL,Lp-PLA2 and dyslipidemia in the prediction and outcome of atherosclerosis in patients with rheumatoid arthritis

Objective To investigate the value of NGAL,Lp-PLA2 and dyslipidemia in the diagnosis and outcome of atherosclerosis(AS)in patients with rheumatoid arthritis(RA).Methods 100 patients with RA(48 patients in remission period and 52 patients in active period)and 50 healthy subjects were selected as the control group.AS examination was performed by an arterial color Doppler ultrasound system.Prevalence of AS and total intima-media thickness(IMT)in the two groups were compared,plasma atherosclerosis index(AIP)was calculated.Hitachi 7600 automatic biochemical analyzer was used to detect total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),apolipoprotein A1(Apo-Al),apolipoprotein B(Apo-B),lipoprotein(Lp)a,serum NGAL and Lp-PLA2 levels were detected by semi-automated immunoturbidimetry.Logistic regression was used to analyze the risk factors of RA combined with AS by using Spearman correlation analysis.Results Compared with the control group,the levels of TC,TG,LDL-C,NGAL and Lp-PLA2 in RA patients were significantly increased,plaque area,plaque thickness and IMT values were significantly increased,and HDL-C content was significantly decreased(P<0.05).Compared with patients with RA remission,the levels of NGAL,Lp-PLA2,plaque area,plaque thickness and IMT were significantly increased in patients with active RA(P<0.05).There were 41 RA patients with AS in the RA group(15 in the death group,26 in the non-death group)and 59 RA patients without AS.Compared with the control group and RA-free AS patients,the levels of TC,TG,LDL-C in RA patients with AS increased significantly,plaque area,plaque thickness and IMT values increased significantly,and HDL-C content decreased significantly(P<0.05).Compared with AS non-death group,the levels of TC,TG and LDL-C in AS death group were significantly increased,plaque area,plaque thickness and IMT values were significantly increased,and HDL-C content was significantly decreased(P<0.05).TC,TG and LDL-C levels,NGAL,Lp-PLA2 levels in patients with RA significantly related with disease severity(active,remission),whether or not combined with AS,disease outcome(survival,death),plaque area,plaque thickness and IMT value(P<0.05).The level of HDL-C in patients with RA was related to the degree of disease(active,remission),whether or not combined with AS,the disease outcome(survival,death),plaque area,plaque thickness and IMT value(P<0.05).Logistic regression analysis showed that the levels of TC,TG and LDL-C,NGAL and Lp-PLA2 in patients with RA were closely related to whether patients had AS and survival outcomes,which were the main independent risk factors(P<0.05).Conclusions The serum levels of NGAL and Lp-PLA2 in patients with RA are elevated and dyslipidemia plays an early role in the pathological process of AS in patients with RA,which is helpful for early detection of AS in patients with RA.