目的：研究旨在評估類風濕關節炎（RA）、係統性紅斑狼瘡（SLE）和係統性硬化症（SSc）患者中頸橈動脈脈搏波速度（PWV）、增強指數（AIx）、肱動脈血流介導性舒張功能（FMD）與其影響因素之間的關係。
方法：研究納入316例患者（包括32%RA、20%SLE和16%SSc）以及156例（32%）對照組。我們使用壓平眼壓測量法檢測動脈僵硬度參數—AIx和PWV，使用超聲測量FMD以反映血管內皮功能。
結果：AIx在3種疾病中均增加（P<0.0001），但風濕性疾病之間無差別。大多數RA患者中PWV值是不正常的（平均較正常組高0.52m/秒），而SSc患者的FMD值卻減低（p=0.006）。平均動脈壓（MBP）是3種疾病的最佳預測因子，其可影響PWVW和AIx，盡管年齡也是AIx的重要變異因素。疾病活動度評分（DAS28）僅與RA患者相關。此外，SLE疾病活動度指數或Rodnan皮膚厚度評分在SSc和炎症標誌物中無統計學意義。
結論：PWV和AIx均依賴於MBP，DAS28可能影響RA患者的AIx，而其他疾病或炎症標誌物可能無影響。MBP是影響RA、SLE和SSc患者動脈僵硬度的主要心血管風險因素，因此需要控製係統性風濕病的MBP。
附原文：
PURPOSE: We aimed to evaluate the association between carotid-radial pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilatation (FMD) of the brachial artery and factors potentially influencing them in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).
METHODS: 316 patients diagnosed with RA (32%), SLE (20%), SSc (16%) and 156 controls (32%) were included in the study. Parameters of arterial stiffness AIx and PWV were obtained using applanation tonometry. FMD reflecting endothelial function was measured by ultrasound.
RESULTS:AIx was increased in all three diseases (p<0.0001), but no differences were found between rheumatic diseases. In most of the RA cases PWV values were abnormal (on average by 0.52m/sec higher than in controls), while in SSc patients FMD values were diminished (p=0.006). Mean blood pressure (MBP) was the most consistent predictive factor in all three diseases, influencing both PWV and AIx, although patient age was also important in variation of AIx. The disease activity score (DAS28) was relevant only in RA patients. Furthermore, SLE disease activity index in SLE or Rodnan skin thickness score had no statistical significance in SSc and inflammatory markers.
CONCLUSIONS:Both, PWV and AIx are dependent on MBP and age DAS28 may affect AIx in RA patients, while other disease or inflammatory markers are unlikely to have any effect. MBP is one of the main cardiovascular risk factors affecting the arterial stiffness in RA, SLE and SSc patients therefore controlling MBP in systemic rheumatic disease patients is mandatory.
引自：Čypienė A, Dadonienė J, Miltinienė D et al. The fact not to ignore: Mean blood pressure is the main predictor of increased arterial stiffness in patients with systemic rheumatic diseases. Adv Med Sci. 2017 May 10;62(2):223-229. doi: 10.1016/j.advms.2017.01.005. [Epub ahead of print]
