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目的探讨不伴有心血管疾病临床表现的类风湿性关节炎(RA)患者肺动脉收缩压力(PASP)与RA疾病活动状态的相关性。方法 RA活动期不伴有心血管疾病临床表现患者55例为RA活动期组,体检健康者50例为对照组。应用超声心动图三尖瓣反流法测量PASP,并测量右室舒张末期和收缩末期横径(RVEDd、RVESd),肺动脉内径(PAD),三尖瓣口舒张早期血流最大速度E峰(E)、舒张晚期血流最大速度A峰(A),计算E/A和右室心肌做功指数(RVMPI);测量血沉(ESR)、C-反应蛋白(CRP)、抗环瓜氨酸肽抗体(Anti-CCP)。结果与对照组比较,RA活动期组RVEDd、RVESd、PAD、A、RVMPI及PASP增大,三尖瓣反流者增多,E/A减低,差异均有统计学意义(均P<0.05)。RA活动期组肺动脉高压(PAH)发生率为26%;RA活动期组PASP与CRP、DAS28、Anti-CCP呈正相关(r值分别为0.545、0.472、0.213,P<0.01)。结论 RA活动期患者在出现明显心血管疾病临床表现前已出现PASP增高,RA活动期炎性免疫机制可能促进患者PASP升高,导致患者右室功能整体下降。
Objective To investigate the relationship between pulmonary artery systolic pressure (PASP) and the activity of RA in patients with rheumatoid arthritis (RA) without clinical manifestations of cardiovascular diseases. Methods 55 patients with RA active stage without clinical manifestation of cardiovascular disease were active RA group and 50 healthy subjects were control group. The echocardiographic tricuspid regurgitation (PASP) was used to measure the PASP. The mean RV diastolic and RVESd, PAD, ), Peak A velocity of late diastolic flow (A), E / A and RVMPI were calculated. ESR, C-reactive protein and anti-cyclic citrullinated peptide antibody were measured Anti-CCP). Results Compared with the control group, the RVEDd, RVESd, PAD, A, RVMPI and PASP increased, the tricuspid regurgitant increased, and the E / A decreased in the active RA group (all P <0.05). The incidence of pulmonary hypertension (PAH) was 26% in RA active stage. PASP was positively correlated with CRP, DAS28 and Anti-CCP in RA active stage (r = 0.545,0.472,0.213, P <0.01). Conclusions Patients with active RA may have increased PASP before the clinical manifestation of obvious cardiovascular disease. The inflammatory immune mechanism may promote the increase of PASP in patients with active RA, leading to the overall decrease of right ventricular function.