平均动脉压影响类风湿和狼疮患者的因素
平均动脉压影响类风湿和狼疮患者动脉僵硬度的主要心血管风险因素
目的：研究旨在评估类风湿关节炎（RA）、系统性红斑狼疮（SLE）和系统性硬化症（SSc）患者中颈桡动脉脉搏波速度（PWV）、增强指数（AIx）、肱动脉血流介导性舒张功能（FMD）与其影响因素之间的关系。
方法：研究纳入316例患者（包括32%RA、20%SLE和16%SSc）以及156例（32%）对照组。我们使用压平眼压测量法检测动脉僵硬度参数—AIx和PWV，使用超声测量FMD以反映血管内皮功能。
结果：AIx在3种疾病中均增加（P<0.0001），但风湿性疾病之间无差别。大多数RA患者中PWV值是不正常的（平均较正常组高0.52m/秒），而SSc患者的FMD值却减低（p=0.006）。平均动脉压（MBP）是3种疾病的最佳预测因子，其可影响PWVW和AIx，尽管年龄也是AIx的重要变异因素。疾病活动度评分（DAS28）仅与RA患者相关。此外，SLE疾病活动度指数或Rodnan皮肤厚度评分在SSc和炎症标志物中无统计学意义。
结论：PWV和AIx均依赖于MBP，DAS28可能影响RA患者的AIx，而其他疾病或炎症标志物可能无影响。MBP是影响RA、SLE和SSc患者动脉僵硬度的主要心血管风险因素，因此需要控制系统性风湿病的MBP。
附原文：
PURPOSE: We aimed to evaluate the association between carotid-radial pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilatation (FMD) of the brachial artery and factors potentially influencing them in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).
METHODS: 316 patients diagnosed with RA (32%), SLE (20%), SSc (16%) and 156 controls (32%) were included in the study. Parameters of arterial stiffness AIx and PWV were obtained using applanation tonometry. FMD reflecting endothelial function was measured by ultrasound.
RESULTS:AIx was increased in all three diseases (p<0.0001), but no differences were found between rheumatic diseases. In most of the RA cases PWV values were abnormal (on average by 0.52m/sec higher than in controls), while in SSc patients FMD values were diminished (p=0.006). Mean blood pressure (MBP) was the most consistent predictive factor in all three diseases, influencing both PWV and AIx, although patient age was also important in variation of AIx. The disease activity score (DAS28) was relevant only in RA patients. Furthermore, SLE disease activity index in SLE or Rodnan skin thickness score had no statistical significance in SSc and inflammatory markers.
CONCLUSIONS:Both, PWV and AIx are dependent on MBP and age DAS28 may affect AIx in RA patients, while other disease or inflammatory markers are unlikely to have any effect. MBP is one of the main cardiovascular risk factors affecting the arterial stiffness in RA, SLE and SSc patients therefore controlling MBP in systemic rheumatic disease patients is mandatory.
引自：Čypienė A, Dadonienė J, Miltinienė D et al. The fact not to ignore: Mean blood pressure is the main predictor of increased arterial stiffness in patients with systemic rheumatic diseases. Adv Med Sci. 2017 May 10;62(2):223-229. doi: 10.1016/j.advms.2017.01.005. [Epub ahead of print]
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