| Objection: To explore the role of blood lipids,inflammatory markers and serological status in RA patients with strokeMethods: Data of all aged 18 and older patients diagnosed of RA and stroke were searched from electronic medical record(EMR)of a third-senior hospital in Liaoning province during January 2011 to March 2018,by using the International Classification of Diseases Tenth Revision(ICD-10)of the Beijing clinical version.RA patients with stroke were defined as the case group,and the patients with RA alone,stoke alone and healthy subjects were defined as the control group matched with three control groups respectively.Sheltering the basic information of patients and laboratory test results,than using Excel2013 software to establish the database.Quantitative data of all case and control groups were compared by Kruskal–Wallis one-way analysis of variance(ANOVA)and post-hoc Dunn's multiple comparison test,meanwhile,the categorical data was analyzed with chi-squared test,above two tests were by using Graph Pad Prism 6.0 software.Binary logistic regression was used to filter the risk factors of RA+stroke group compared to other groups separately,meanwhile comparing these final models to adjust confounders,by using SPSS software version 23.0.Finally,restricted cubic spline was adopted to examine the relationship between stroke and serum biochemical level in RA patients,and plot the restricted cubic spline graph in SAS software version 9.3.Results: A total of 1057 subjects were included in this study,including 151 RA+ stroke,302 simple RA,302 simple stroke,and 302 control cases.By comparison of lipid profiles and metabolic changes among the four groups and comparing inflammatory markers,serological status between RA patients with and without stroke,and further to explore the association between lipid levels,inflammatory markers and risk of stroke among RA patients.Showing as following:(1)In the final model of RA+stroke group versus RA group,the independent risk factors for stroke development in RA patients were listed as ESR ? 20 mm/h(OR=5.39(2.52,11.55),P<0.0001),LDL-C ? 3.4 and <4.1 mmol/L(OR=0.2(0.04,0.85),P=0.029),LDL-C ?4.1 mmol/L(OR=1.84(0.61,5.5),P=0.279)and CRP ? 8 mg/L(OR=0.15(0.07,0.34),P<0.0001).(2)In the final model of RA+stroke group versus health control group,the significant risk factors were found to be diabetes(OR=3.76(1.91,7.40),P<0.0001),LDL-C ?4.1 mmol/L(OR=3.30(1.40,7.80),P=0.006),TG?1.70(OR=0.52(0.27,1.00),P=0.049),TG?2.30 g/L(OR=0.34(0.15,0.80),P=0.014),and the abnormal level of BMI.(3)In the final model of RA group versus health control group,the risk of RA patients was associated with HDL-C<1.04 mmol/L(OR=2.96(1.41,6.22),P=0.004),diabetes(OR=6.1(3.22,11.59),P<0.0001),TG?1.70,and ?2.30g/L(OR=0.32(0.16,0.65),P=0.002;OR=0.27(0.11,0.65),P<0.003;respectively)and higher BMI.Finally,conducting dose-response analysis of the association between lipid levels,inflammatory markers and risk of stroke among RA patients.Our results indicated a significant linear association between LDL-C level,ESR level and risk of comorbid stroke among RA patients.A similar upturned funnel shaped association was found between serum CRP level and the risk of stroke among RA patients,with significant non-linearity.By considering CRP level of 8 mg/L as the reference value,with every 50 and 100 mg/L increased of CRP levels,the study suggested that much higher CRP levels may increase the risk of stroke development among RA patients.Conclusions: In summary,our findings underlined the importance of systemic inflammation and demonstrated the complicated role of dyslipidemia for the risk of stroke in patients with RA.Thus,more attention should be paid to RA patients with increased levels of ESR,LDL-C and CRP,for the prevention of stroke comorbidity. |
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