【摘要】 目的 采用高分辨率超聲測定類風濕關節炎（rheumatoid arthritis，RA）患者頸動脈內中膜厚度和是否有斑塊以及是否存在動脈硬化。 方法 分析2009年4月—2010年9月間150例RA患者的一般情況、發病情況、疾病活動性評分（DAS28評分），及實驗室指標如:血沉（ESR）、C反應蛋白（CRP）、抗環瓜氨酸抗體（ACCP）、類風濕因子（RF）、總膽固醇、三酰甘油、高密度脂蛋白膽固醇（HDL-C）、低密度脂蛋白膽固醇（LDL-C）、載脂蛋白A1 （ApoA1）、載脂蛋白B（ApoB）、脂蛋白a及血尿酸的測定。采用頸動脈彩色多普勒超聲測定RA患者與正常對照組120例頸動脈內中膜值及是否有斑塊。 結果 150例RA患者20例出現動脈硬化，120例健康人群中3例出現動脈硬化，RA頸動脈內硬化危險因素單因素分析中，病程、DAS28評分、ApoA1、ApoB、HDL-C及尿酸與RA動脈硬化有關，而年齡、性別、ESR、CRP、RF、ACCP等與RA發生動脈硬化無關；RA動脈硬化多因素回歸分析示:病程、尿酸及高密度脂蛋白是RA發生動脈硬化的危險因素。 結論 頸動脈內中膜測定對RA動脈硬化具有一定臨床價值。【Abstract】 Objective To detect the carotid artery intima-media thickness and the existence of carotid plague and arteriosclerosis by high-resolution ultrasonography in patients with rheumatoid arthritis (RA). Methods A total of 150 RA patients treated in our hospital between April 2009 and September 2010 were included in this study. Their general condition, onset of the disease and disease activity score (DAS28 scoring) were analyzed. Laboratory indexes like erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Anti-cyclic citrullinated peptide (ACCP) antibody, rheumatoid factor (RF), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apo A1), apolipoprotein B (apo B), lipoprotein(a) (Lp(a)), and uric acid (UA) were measured. Carotid color ultrasonography was used to detect the carotid intima-media thickness and the existence of carotid plague in 150 patients with RA and 120 patients in the control group. Results Twenty out of the 150 RA patients and three out of the 120 controls manifested arteriosclerosis. Single factor analysis showed a correlation between arteriosclerosis in RA patients and course of disease, DAS28 scoring, Apo A, Apo B, HDL-C, and UA, and no correlation between arteriosclerosis and age, gender, ESR, CRP, RF, and ACCP. Multivariate regression analysis showed that the course of disease, UA and HDL-C are independent risk factors for arteriosclerosis in RA patients. Conclusion Analysis of the carotid intima-media has a certain clinical value in predicting arteriosclerosis in RA patients.
