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投稿时间：2025-02-18 网络发布日期：2025-10-20
投稿时间：2025-02-18 网络发布日期：2025-10-20
中文摘要: 目的 探讨类风湿性关节炎（RA）患者血清低密度脂蛋白胆固醇（LDL-C）、脂蛋白相关磷脂酶 A2（Lp-PLA2）、载脂蛋白 B（Apo-B）/载脂蛋白 A1（Apo-A1）比值变化及其与患者合并动脉粥样硬化（AS）的关系。方法 回顾性选取2021年1月至2023年12月山东大学齐鲁医院德州医院RA患者118例纳入RA组，另选取同期性别、年龄相匹配的体检健康者60例纳入对照组；并以超声检测RA患者颈动脉内膜中层厚度（IMT）增厚或/和出现动脉斑块定义为颈动脉AS形成，将118例RA患者分为合并AS亚组（n=57）和未合并AS亚组（n=61），比较两组、RA两亚组血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值差异。经logistic回归分析RA患者合并AS的危险因素，Pearson相关法分析血清指标与颈动脉IMT水平的关系。结果 RA组患者血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值均高于对照组（t=9.352、11.880、8.443，P <0.01）。RA患者中，合并AS亚组的高血压占比以及年龄、病程、28个关节的疾病活动评分均高于未合并AS亚组（P<0.05），血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值均高于未合并AS亚组（t=10.491、8.552、5.009，P<0.05）。Logistic回归分析结果显示，高龄、高血压病史、RA病程长、疾病活动度高以及血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值高是RA患者并发AS的独立危险因素（P <0.01）；RA患者血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值分别与颈动脉IMT呈正相关（r=0.522、0.580、0.619，P <0.01）。结论 RA合并AS患者的血清LDL-C、Lp-PLA2、Apo-B/Apo-A1比值升高，与颈动脉IMT呈正相关，其高水平是促进RA患者AS形成的风险因素。
Abstract:Objective To investigate the changes of serum low density lipoprotein cholesterol（LDL-C），lipoprotein-associated phospholipase A2（Lp-PLA2）and apolipoprotein（Apo）-B / Apo-A1 in rheumatoid arthritis（RA）patients and their relationship with atherosclerosis（AS）. Methods A total of 118 patients with RA in Dezhou Hospital，Qilu Hospital of Shandong University from January 2021 to December 2023 were retrospectively selected as the RA group，and 60 healthy people with matched sex and age were selected as the control group. The thickening of carotid intima media thickness（IMT）and/or the appearance of arterial plaque was defined as carotid AS，and 118 RA patients were divided into subgroups with AS（n=57）and without AS（n=61），and the differences in serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 ratio between the two groups and the two subgroups were compared. Logistic regression model was used to analyze the risk factors for RA patients complicated with AS，and Pearson correlation method was used to analyze the relationship between serum indexes and carotid IMT level. Results The levels of serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 in RA group were higher than those in control group（t=9.352、11.880、8.443，P <0.01）. Among RA patients，the age，course of disease，28-joint Disease Activity Score and proportion of hypertension in subgroup with AS were higher compared to subgroup without AS（P<0.05），and the levels of serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 were higher compared to subgroup without AS（t=10.491、8.552、5.009，P<0.05）. The Results of logistic regression analysis showed that advanced age，hypertension history，long course of RA，high disease activity，high levels of serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 were independent risk factors of AS in RA patients. The levels of serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 were positively correlated with carotid IMT，respectively（r=0.522，0.580，0.619，P <0.01）. Conclusion The levels of serum LDL-C，Lp-PLA2 and Apo-B/Apo-A1 are higher in RA patients complicated with AS，which are positively correlated with IMT of carotid artery，and their high levels are risk factors that promote the formation of AS in RA patients.
keywords: Rheumatoid arthritis Atherosclerosis Low density lipoprotein cholesterol Lipoprotein-associated phospholipase A2 Apolipoprotein B Apolipoprotein A1 Carotid intima media thickness
文章编号： 中图分类号：R593.22 R543.5 文献标志码：A
基金项目:山东省中医药科技项目（2020M176）
附件
| Author Name | Affiliation |
| YANG Na，LYU Jing，WANG Xuguang，WEN Shuyun，LI Yun | Department of Chinese Medicine,Dezhou Hospital,Qilu Hospital of Shandong University,Dezhou,Shandong 253000,China |
引用文本：
杨娜，吕婧，王旭光，温淑云，李云.类风湿性关节炎合并动脉硬化患者血清脂代谢三个指标水平的变化及其意义[J].中国临床研究,2025,38(10):1559-1562.
杨娜，吕婧，王旭光，温淑云，李云.类风湿性关节炎合并动脉硬化患者血清脂代谢三个指标水平的变化及其意义[J].中国临床研究,2025,38(10):1559-1562.