Факторы риска развития стеноза коронарных артерий у больных ревматоидным артритом
Автор: Герасимова Е.В., Попкова Т.В., Новикова Д.С., Круглый Л.Б., Фомичева О.А., Карпов Ю.А., Насонов Е.Л.
Журнал: Научно-практическая ревматология @journal-rsp
Рубрика: Оригинальные исследования
Статья в выпуске: 6 т.55, 2017 года.
Бесплатный доступ
Цель исследования - определить частоту и степень атеросклеротического поражения коронарных артерий по данным коронароангиографии у больных ревматоидным артритом (РА) с подозрением на ишемическую болезнь сердца (ИБС), оценить связь его развития с традиционными факторами риска (ФР), маркерами воспаления и терапией РА. Материал и методы. В исследование включено 25 мужчин и 38 женщин с диагнозом РА и подозрением на ИБС или с верифицированной ИБС, медиана возраста - 58 [52; 63] лет, длительности РА - 10,5 [7; 23] года. 85% больных были серопозитивны по IgM ревматоидному фактору (РФ), 69% - по антителам к циклическому цитруллинированному пептиду (АЦЦП). Медиана DAS28 - 4,7 [3,3; 5,8]. Стеноз коронарных артерий диагностировали при наличии гемодинамически значимого сужения их просвета (>50%). Результаты и обсуждение. Стеноз коронарных артерий диагностирован у 22 (35%) больных (I группа), из них у 15 (68%) поражение было однососудистым, у 7 (32%) - трехсосудистым; двухсосудистого поражения не было ни у одного пациента с РА. У 41 (65%) больного изменений коронарных артерий не обнаружено (II группа). У мужчин частота стеноза коронарных артерий (15 из 25; 60%) оказалась выше, чем у женщин (7 из 38; 18%; р0,05). Проведенный множественный регрессионный анализ не выявил связи развития стеноза коронарных артерий с возрастом, полом, значением DAS28, СОЭ, уровнем С-реактивного белка, концентрацией ХС, ХС липопротеидов низкой плотности (ЛПНП), ХС ЛПВП, применением противоревматических препаратов. Изучавшиеся показатели не позволили прогнозировать развитие стеноза коронарных артерий, хотя различия по возрасту приближались к уровню статистической достоверности: отношение шансов (ОШ) - 0,85 (95% ДИ 0,72-1,0); р=0,05. Остальные параметры, включая уровень ХС ЛПВП
Ревматоидный артрит, стеноз коронарных артерий, традиционные факторы риска, атеросклеротическое поражение сосудов
Короткий адрес: https://sciup.org/14945873
IDR: 14945873 | DOI: 10.14412/1995-4484-2017-628-633
Risk factors of coronary artery stenosis in patients with rheumatoid arthritis
Objective: to determine frequency and grade of the coronary artery (CA) damage using coronary angiography data in patients with rheumatoid arthritis (RA) and suspected coronary artery disease (CAD); to evaluate the association of its progress with traditional risk factors (TRF), inflammatory markers and antirheumatic therapy. Subjects and methods. 25 male and 38 female RA patients with suspected or verified CAD, (median age was 58 [52; 63] years, RA duration - 10,5 [7; 23] years), were included in the study. 85% of patients were seropositive for IgM rheumatoid factor, 69% - for cyclic citrullinated peptide (CCP) antibodies. DAS28 median was 4,7 [3,3; 5,8]. CA stenosis was diagnosed if hemodynamically significant narrowing of the artery lumen (>50%) was present. Results and discussion. CA stenosis was diagnosed in 22 (35%) patients (group I), 15 (68%) of them had single vessel damage, 7 (32%) - three-vessel involvement; the damage of two vessels was not diagnosed in any RA case. 41 (65%) patients had no lesions in CA (group II). The frequency of CA stenosis was higher in male patients (15 out of 25; 60%) than in female (7 out of 38; 18%; p0,05). The multiple regression analysis did not revealed any direct relationship of CA stenosis development with age, gender, DAS28, erythrocyte sedimentation rate, C-reactive protein level, concentration of cholesterol, low density lipoprotein cholesterol, HDLC, and consumption of anti-rheumatic drugs. The prediction of CA stenosis development was not possible with parameters used in this study. However, differences in age were the closest to statistical significance (0R=0,85; 95% CI [0,72-1,0], p=0,05). Other parameters, including HDLC level
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