The Clinical Study On Carotid Atherosclerosis Of Rheumatoid Arthritis

Objective:To evtaluae the prevalence of carotid atherosclerosis in rheumatoid arthritis(RA) and study possible risk factors with carotid atherosclerosis of rheumatoid arthritis, to evtaluae the correlation between carotid atherosclerosis and myocardial ischemia in rheumatoid arthritis. To provide evidence on prevention and treatment of RA patients with cardio-cerebral vascular system disease.Methods:By retrospective analysis, we investigated 60 RA patients who accepted the first treatment in our hospital and 60 healthy controls. Carotid ultrasonic exam ination was applied to detect intima-media thickness(IMT) of carotid artery and plaque. The frequency of risk factors for carotid atherosclerosis in RA patients and controls was compared, and the relationship between the RA patients'clinical characteristics and carotid plaque was examined. Choose targets which possibly influence carotid atherosclerosis to do single factor analysis. Do Logistic-rsgression analysis about the targets which have statistical significance (P<0.1) in ingle factor analysis and study possible risk factors with carotid atherosclerosis of rheumatoid arthritis. According to the results of ambulatory electrocardiography, the RA patients were divided myocardial ischemia group and ischemia-free group. The correlations were analyzed between myocardial ischemia, common carotid artery IMT and carotid plaque. The receiver operating characteristic (ROC)curves were used to evaluate the sensitivity and specificity of carotid artery IMT in predicting the presence of myocardial ischemia in RA patients.Results:Compared with controls, triglyceride(TG), low density lipoprotein-cholesterol (LDL-C), apolipoprotein B(ApoB), lipoprotein(a) [LP(a)] levels were found increased in RA patients, and high density lipoprotein-cholesterol (HDL-C) levels were decreased; 86.7% RA patients complicated with dyslipoproteinemia. Compare RA patients with healthy controls:both the IMT and the plaque of the conmon carotid artery incidence increased. Both carotid osteoporosis and carotid plaque formation incidence increased in RA patients was influenced by age, systolic blood pressure(SBP), menopausal, TC, TG, LDL-C, ApoB, C-reactive protein(CRP), erythrocyte sedimentation rete (ESR), fibrinogen (FG), disease duration and osteoporosis (OP). Using Logistic-rsgression analysis, we found that the major risk factors of carotid atherosclerosis in RA patients are SBP, LDL-C, FG, OP (OR=1.054, P=0.034; OR=6.319, P=0.012; OR=9.966, P=0.003; OR=8.203, P=0.006 respectively). The incidence of the carotid artery IMT and the carotid plaque in the RA patients with myocardial ischemia was significantly higher than that in the RA patients without myocardial ischemia (P<0.05, P<0.01). Myocardial ischemia in RA patients was positively correlated to the IMT and plaque of the common carotid artery (r=0.304, P=0.005; r=0.499, P=0.000). The area under cure (AUC) of the ROC curve of IMT was 0.770±0.062, P=0.000. Asymptotic 95% Confidence Interval(95% CI) was 0.648-0.892.Conclusions:RA patients had significantly dyslipoproteinemia, characterized by an increase in TG, LDL-C, ApoB, LP(a) and decrease in HDL-C. RA patients preseneted a higher prevalence of carotid atherosclerosis and carotid plaque than healthy controls. Traditional cardiovascular risk factors and disease-related factors were associated with carotid atherosclerosis in RA.The major risk factor of RA patients complicated with carotid atherosclerosis were SBP, LDL-C, FG, OP.Carotid atherosclerosis and carotid plaque formation show a positive correlation to the onset of myocardial ischemia in RA patients, but the common carotid artery IMT is not accurate markers for predicting myocardial ischemia in RA patients.