摘要
目的 探讨类风湿关节炎(RA)患者血液炎症指数与心血管风险之间的关系,为RA患者心血管风险的管理提供依据。方法 回顾性收集RA患者入院和随访时(入院及随访两个时间点间隔为1年±10天)临床资料,包括入院时一般资料,入院时及随访时患者外周血中性粒细胞、淋巴细胞、单核细胞、血小板、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)指标,计算血液炎症指数[包括中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)、全身炎症反应指数(SIRI)]及血浆动脉粥样硬化指数(AIP)。采用交叉滞后模型,分析RA患者血液炎症指数与AIP之间的关系,并探索二者的关系在不同性别之间的差异。结果 共有633例RA患者纳入本项研究,其中男性141例(22.27%),女性492例(77.73%),男性中吸烟、饮酒的比例以及体重指数均显著大于女性(P<0.05)。633例患者随访时NLR、MLR、PLR、SII、SIRI水平均高于入院时(P<0.05),而入院和随访时AIP水平差异无统计学意义(P>0.05)。女性入院时NLR、MLR、PLR、SII、SIRI、AIP水平均显著高于男性(P<0.05)。633例患者中,NLR、MLR、PLR、SII、SIRI与AIP间均存在显著双向因果关联(P<0.05)。基于性别分层的时间因果分析显示,女性NLR、MLR、PLR、SII与AIP均存在双向关联,AIP→SIRI之间为单向关系(P<0.05)。男性SII与AIP之间互为因果(P<0.05),AIP→NLR、AIP→MLR、AIP→PLR及AIP→SIRI呈单向关联(P<0.05),SIRI与AIP无显著关联(P>0.05)。结论 RA患者血液炎症指数与AIP之间存在双向因果关联,可相互预测1年后各指数的变化;女性的血液炎症指数与AIP之间的因果关联性较男性更强。
Objective To investigate the relationship between hematological inflammatory indices and cardiovascular risk in rheumatoid arthritis(RA)patients,providing insights for cardiovascular risk management strategies.Methods Clinical data of RA patients were retrospectively collected at admission and follow-up(1 year±10 days between admission and follow-up).The data included general information at admission,and peripheral blood neutrophil,lymphocyte,monocyte,platelet,triglyceride(TG),and high-density lipoprotein cholesterol(HDL-C)levels at both admission and follow-up.Blood inflammatory indicators including neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammatory index(SII),and systemic inflammatory response index(SIRI)and atherogenic index of plasma(AIP)were calculated.Cross-lagged panel model was used to analyze the relationship between blood inflammatory markers and AIP in patients with RA.Gender-stratified analyses were performed.Results A total of 633 RA patients were included in this study,of whom 141 were male(22.27%)and 492 were female(77.73%).The proportions of smokers and drinkers,and body mass index were significantly higher in male than in female(P<0.05).At follow-up,the levels of NLR,MLR,PLR,SII,and SIRI in all 633 patients were higher than at admission(P<0.05),while there was no statistically significant difference in AIP levels between admission and follow-up(P>0.05).At admission,female patients had significantly higher levels of NLR,MLR,PLR,SII,SIRI,and AIP than male patients(P<0.05).Among 633 patients,significant bidirectional causal associations were found between NLR,MLR,PLR,SII,SIRI and AIP(P<0.05).Stratified temporal causal analysis based on gender showed that in females,NLR,MLR,PLR,SII and AIP were bidirectionally associated,while the relationship between AIP and SIRI was unidirectional(P<0.05).In males,SII and AIP were mutually correlated(P<0.05),while AIP→NLR,AIP→MLR,AIP→PLR,and AIP→SIRI showed unidirectional associations(P<0.05),and SIRI had no significant association with AIP(P>0.05).Conclusion There is a bidirectional causal association between blood inflammatory markers and AIP in RA patients,and they can mutually predict changes in each marker after 1 year;the causal association between blood inflammatory markers and AIP is stronger in female than in male.
作者
彭秋伟
姜泉
PENG Qiuwei;JIANG Quan(Guanganmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053)
出处
《中医杂志》
北大核心
2025年第23期2447-2452,共6页
Journal of Traditional Chinese Medicine
基金
国家自然科学基金(82230121)
中国中医科学院科技创新工程(CI2023C019YL)。
关键词
类风湿关节炎
心血管疾病
风险分析
交叉滞后模型
炎症指数
rheumatoid arthritis
cardiovascular disease
risk analysis
cross-lagged panel model
inflammatory index
