A Cross-sectional Study Of Cardiovascular Risk Factors In Different TCM Syndromes Of Rheumatoid Arthritis

ObjectiveTo explore the correlation between TCM syndrome type and cardiovascular risk factors of rheumatoid arthritis(RA),and to provide clinical reference for TCM syndrome differentiation of RA cardiovascular disease.MethodsThis study included a total of 87 RA patients admitted to the Department of Rheumatology,Oriental Hospital,Beijing University of Chinese Medicine from January 2017 to December 2017.The syndromes were identified as dampness and cold dampness,and dampness and heat retention syndromes.The following indicators were collected:? General condition and Demographic data,? Haematological parameters:RA related indicators RF,anti-CCP,ESR,CRP,IgA,IgG,IgM and lipids TC,TG,HDL,LDL,ApoAl,ApoB,Lp(a),and UA,GLU,Hcy,? ECG,?cardiac ultrasound:AO,LA,LVDd,LVDs,LVPW,EF,FS,SV,RV,RA,IVS,ASE,? Carotid ultrasound:carotid ultrasound,carotid artery Thickening situation and cIMT,? TCM syndrome type points.The correlation between RA and cardiovascular risk factors in different TCM syndromes was analyzed.Results1.Baseline data:Of all the included RA,47 were cold dampness syndromes,and 40 were dampness-heat syndromes.All patients were active.There was no significant difference in gender,age,duration of illness,WBC,RBC,RF positive,and anti-CCP positive status between the two groups(P>0.05).However,the HGB level of cold dampness phlegm was higher than that of dampness and heat phlegm.P=0.021<0.05),while PLT,VAS score and DAS28 level were significantly higher in damp-heat phlegm and blood stasis syndrome than in cold dampness phlegm(P=0.023<0.05 and P=0.000<0.01).2.Cardiovascular risk factors related indicators between the two RA syndromes:(1)The related indicators of traditional cardiovascular risk factors between the two RA syndromes:?Smoking status:The proportion of hot and humid stasis syndrome smoking was higher than that of cold dampness stasis syndrome(P=0.033<0.05);? lipids:TC,LDL,ApoB,Lp(a)were not significantly different between the two groups(P>0.05),but TG,HDL,and ApoA1 levels were higher than that of dampness and heat phlegm.(P<0.05);?Prevalence of hypertension,diabetes,dyslipidemia,and coronary heart disease:The proportion of patients with hypertension and dyslipidemia was significantly higher than that of cold dampness stasis syndrome(P=0.018<0.05 and P=0.047<0.05),but the prevalence of diabetes mellitus and coronary heart disease did not differ between the two groups(P>0.05)?BMI,Hcy,GLU,UA situation:RA dampness and cold dampness stagnation syndrome and damp heat stasis syndrome in two groups of patients BMI,Hey,GLU There was no significant difference in the level(P>0.05),but the blood UA level in patients with cold dampness stasis syndrome was higher than that of damp heat stasis syndrome(P=0.041<0.05);(2)Non-traditional cardiovascular risk factors related indicators of two syndrome types:?Inflammation index:CR and ESR of RA damp and heat blockage were significantly higher than those of cold dampness(P<0.05 or P<0.01);? Globulin:RA cold dampness phlegm and damp heat phlegm syndrome IgG,IgA,IgM levels were no significant difference between the two groups(P>0.05);?ECG situation:RA cold dampness phlegm and damp heat phlegm in patients with There was no statistically significant difference in ECG(P>0.05).? Cardiac ultrasound related indicators:RA,dampness,sputum,dampness and heat blockage syndrome.AO,LA,LVDd,LVDs,LVPW,FS,RV,RA,and IVS There was no significant difference in level and A/E(P>0.05),but the HF and SV levels of EF and SV were higher than those of dampness and heat phlegm(P<0.05).? Carotid artery ultrasound related indexes:RA dampness phlegm and dampness fever There was no significant difference between the two groups in the occurrence of carotid ultrasound and the thickening of the carotid artery(P>0.05).However,the damp heat resistance of the cIMT level was significantly higher than that of the cold dampness(P<0.05).?Medication situation:only use of leflunomide and prednisone acetate tablets exists between the two groups The difference between the use of hot and humid phlegm and leflunomide and prednisone acetate was higher than that of cold dampness phlegm(P=0,047<0.05 and P=0.039<0.05).There was no statistical difference between the two groups(P>0.05).3.Two syndromes of TCM syndrome scores:In patients with RA damp-heat syndrome,the TCM syndrome scores and total TCM syndrome scores in joint swelling,joint pain,joint tenderness,and flexion-extension are all significantly higher than those in Hanshi syndrome(P=0.000<0.01).4.Correlation between RA related indicators and cardiovascular risk factors:(1)Correlation between RA related indicators and BMI and age:BMI was positively correlated with CRP(r=0.236,P=0.028<0.05).There was no significant difference between ESR,RF,CCP,VAS score,DAS28,and TCM syndrome scores.Correlation(P>0.05);age and RA-related indicators were not significantly related(P>0.05);(2)the correlation of RA related indexes and blood lipid levels:ESR and CRP were negatively correlated with TC,TG,HDL and ApoAl(P<0.05 or P<0.01),and had no significant correlation with LDL,ApoB and Lp(a)(P>0.05).RF and anti-CCP had no significant correlation with blood lipid levels(P>0.05);VAS score was negatively correlated with LDL(r=-0.216,P=0.044),and TC,TG,and HDL There was no significant correlation between ApoAl,ApoB,and Lp(a)(P>0.05).DAS28 and total scores of TCM syndromes were negatively correlated with TG(P<0.05).There was no significant correlation between them(P>0.05);(3)Correlations between RA-related indicators and GLU,UA,and Hey:ESR and UA were negatively correlated(r=-0.259,P=0.015<0.05),and there was no significant correlation between GLU and Hey(P>0.05).CRP and VAS scores were positively correlated with GLU(r=0.232 and 0.293,P<0.05),but not with UA and Hey(P>0.05).DAS28 was positively correlated with GLU and Hey(r=0.244 and 0.274,respectively).P<0.05),no significant correlation with UA(P>0.05);TCM syndrome total score was positively correlated with Hey(r=0.264,P=0.013<0.05),and there was no significant correlation between GLU and UA(P>0.05);RF,anti-CCP and GLU,UA,Hey were not significantly related;(4)Correlation between RA-related indicators and cardiac ultrasound-related indicators and cIMT:ESR was positively correlated with LA(r=0.267,P=0.012<0.05),and negatively correlated with EF and FS(r=-0.231 and r=-0.226,P<0.05).There was no significant correlation with AO,IVS,LVDd,LVDs,LVPW,SV,RV,RA,cIMT(P>0.05).CRP was positively correlated with LA,IVS5 and LVDs(r= 0.343,0.218,and 0.261,P<0.05 or P<0.01).No significant correlation with AO LVDd,LVPW,EF,FS,SV,RV,RA,cIMT(P>0.05);RF,anti-CCP,VAS scores,DAS28,total scores of TCM syndromes were not significantly correlated with cardiac ultrasound parameters and cIMT(P>0.05).Conclusions1.RA TCM syndrome and cardiovascular disease risk factors have a certain correlation,dampness heat blockage syndrome cardiovascular disease risk may be higher than that of cold dampness syndrome;2.There was a degree of correlation between RA related indicators and cardiovascular risk factors.