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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((3RP)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。
Objective To analyze the incidence and incidence of cardiovascular and cerebrovascular diseases (CCVD) in patients with rheumatoid arthritis (RA) and to explore the risk factors associated with CCVD in RA patients. Methods The clinical data of 568 patients with RA were retrospectively analyzed. The prevalence, laboratory tests, treatment regimens, treatment response (European Anti-Rheumatic EULAR response standard), prevalence of CCVD and traditional risk factors were analyzed retrospectively. Risk factors. Results (1) There were 92 cases (16.20%) of RA combined with CCVD, including 49 cases of coronary atherosclerotic heart disease (53.26%), 21 cases of cerebrovascular disease (22.83%), hypertensive Coronary heart disease in 12 cases, accounting for 13.04%, of which 2 cases with heart failure; color Doppler prompted large - atherosclerotic plaque in 6 cases, accounting for 6.52%; gangrenous gangrene in 4 cases (4.34%). (2) Whether RA combined with CCVD was related to DAS28’s activity score, platelet count, C-reactive protein (3RP) level and extra-articular organ involvement (P <0.001, OR = 9.67, P <0 .015, OR = 6.91; P <0.003, OR = 1.35; P <0.015, OR = 2.14), and had no relation with the risk factors and the number of CCVD. (3) Treatment response and whether effective risk factors were involved in the long-term use of Cox-2-selective non-steroidal antirheumatic drugs in combination with higher-dose glucocorticoid therapy (P = 0.006, RR = 2.31; P <0.001, RR = 5.90; P <0.001, RR = 2.63; P = 0.013, RR = 1.34) .Conclusion The incidence of CCVD in RA patients is high, Sexual reaction, involvement of extra-articular organs, poor response to therapy, long-term use of higher doses of glucocorticoid and Cox-2 inhibitors and no effective traditional risk factors for intervention with RA combined with CCVD Risk factors.