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全国多中心类风湿关节炎冠心病危险因素的现况调查
A multicenter study of coronary artery disease and its risk factors in rheumatoid arthritis in China

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李春 1   王秀茹 1   唐熠达 2   安媛 1   周云杉 1   郭时伟 1   张晓盈 1   段天骄 1   朱佳鑫 1   李晓峰 3   王莉枝 3   王彩虹 3   王永福 4   杨荣 4   王国春 5   卢昕 5   朱平 6   陈丽娜 6   靳洪涛 7   刘金婷 7   刘湘源 8   孙琳 8   陈海英 9   魏平 9   王俊祥 9   崔刘福 10   舒荣 10   刘白鹭 10   张卓莉 11   李光韬 11   李振彬 12   杨静 12   李俊芳 13   贾彬 13   张风肖 14   陶杰梅 14   韩淑玲 15   林金盈 16   韦美秋 16   刘晓敏 17   柯丹 17   胡绍先 18   叶丛 18   杨岫岩 19   李昊 19   黄慈波 20   高明 20   赖蓓 20   李兴福 21   宋立军 21   王轶 22   王晓元 22   穆荣 1 *   苏茵 1   栗占国 1 *  
文摘 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%vs.7.0%,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。
其他语种文摘 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±9.3) years vs.(52.3±14.0) years,P<0.001],more rheumatoid nodules(14.7% vs.3.1%,P=0.005),lower rate of hydroxychloroquine(HCQ) use(5.9% vs.22.6%,P=0.021),higher prevalence rates of lung interstitial disease(17.5% vs.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.
来源 北京大学学报. 医学版 ,2012,44(2):176-181 【核心库】
关键词 关节炎,类风湿 ; 冠心病 ; 危险因素 ; 患病率
地址

1. 北京大学人民医院风湿免疫科, 北京, 100044  

2. 中国医学科学院北京协和医学院阜外心血管病医院心内科, 北京, 100037  

3. 山西医科大学第二医院风湿免疫科, 太原, 030001  

4. 包头医学院第一附属医院风湿免疫科, 包头, 014010  

5. 中日友好医院风湿免疫科, 北京, 100029  

6. 第四军医大学西京医院风湿免疫科, 西安, 710032  

7. 河北医科大学第二医院风湿免疫科, 石家庄, 050000  

8. 北京大学第三医院风湿免疫科, 北京, 100191  

9. 河北医科大学第三医院风湿免疫科, 石家庄, 050001  

10. 华北煤炭医学院附属开滦医院风湿免疫科, 唐山, 063000  

11. 北京大学第一医院风湿免疫科, 北京, 100034  

12. 白求恩国际和平医院风湿免疫科, 石家庄, 050082  

13. 河北邯郸中心医院风湿免疫科, 邯郸, 056001  

14. 河北省人民医院风湿免疫科, 石家庄, 050051  

15. 北京大学首钢医院风湿免疫科, 北京, 100144  

16. 广西壮族自治区人民医院风湿免疫科, 南宁, 530021  

17. 北京顺义区医院风湿免疫科, 北京, 101300  

18. 华中科技大学同济医学院附属同济医院风湿免疫科, 武汉, 430030  

19. 中山医科大学附属第一医院风湿免疫科, 广州, 510080  

20. 北京医院风湿免疫科, 北京, 100730  

21. 山东大学齐鲁医院风湿免疫科, 济南, 250012  

22. 兰州大学第二医院风湿免疫科, 兰州, 730030

语种 中文
文献类型 研究性论文
ISSN 1671-167X
学科 内科学
基金 国家“十一五”科技支撑计划项目
文献收藏号 CSCD:4503644

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引证文献 11

1 马艳苗 风湿宁胶囊对胶原诱导性关节炎大鼠滑膜细胞超微结构及细胞凋亡相关基因表达的影响 中医杂志,2013,54(4):326-328,335
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2 史晓飞 应重视类风湿关节炎流行病学伴发疾病致残率及就医行为的研究 中华风湿病学杂志,2014,18(7):433-436
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