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Background Rheumatoid arthritis (rheumatoid arthritis, RA) a high incidence of cardiovascular disease in recent years, attention, which accounts for 42% of the cause of death in patients with RA, and traditional cardiovascular risk factors (hypertension, high cholesterol, diabetes, smoking, etc.) does not fully explain the occurrence of cardiovascular disease in patients with RA, chronic inflammatory factors may play an important role, but the occurrence of RA patients with cardiovascular lesions, and inflammation factors in RA patients with cardiovascular disease, such as arterial atherosclerotic hardening (atherosclerosis, AS) in the role of domestic has not been reported. Purpose by the neck and heart color Doppler ultrasonography (ultrasound cardiogram, UCG) check for the occurrence of heart attack and atherosclerosis in RA patients, and gender and age to match the normal control group; simultaneous detection of macrophage migration in RA patients inhibition factor (macrophage migration inhibitory factor, the MIF), interleukin-17 (interleukin-17, of IL-17), White mediated Su-23 (interleukin-23, IL-23), autoantibodies and clinical indicators such as, analysis of inflammatory cytokines and RA merger AS to explore the role of inflammatory factors in RA merge AS. Methods 2009.9-2010.5 Division of Rheumatology hospitalized in the First Affiliated Hospital of Anhui Medical University and the exclusion of traditional cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, smoking 69 cases of patients with RA, detailed records of each patient's clinical indicators detected ESR (erythrocyte sedimentation rate, ESR), C-reactive protein (C reactive protein, CRP), rheumatoid factor (rheumatoid factor, RF), anti-cyclic citrullinated (cyclic citrulline polypeptide, CCP) antibodies; choose the age and gender match 76 cases of healthy volunteers as a control, the two groups of cardiac and carotid color Doppler Ultrasound detection of carotid intima-media thickness (maximum the intima media thickness, M-IMT) and ventricular septal thickness (interventricularseptal thickness, IVS ), the number of heart function indicators. According to the the neck vascular ultrasound results, divided into combined AS group, RA RA without AS group and NC group, using enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA) method detected three groups of serum MIF, IL-17, IL- 23 and analysis of the level of their correlation. Results 1. Echocardiography results show 78.26% (54/69 cases) of patients with RA abnormal the order reduced left ventricular compliance 30 cases of valvular regurgitation in 22 cases, six cases aortic calcification associated with a small amount of regurgitation, arrhythmia Qi four cases; echocardiography exception occurred only in the normal control group was 26.32% (20/76 cases), the difference was statistically significant (X to 2 = 39.05, p lt; 0.01). The two sets of ECG abnormalities incidence difference was not statistically significance (13.04% vs. 9.21%, p gt; 0.05). 2. Compared with the normal control group, RA patients with right ventricular diameter (21.69 ± 3.32 vs 20.47 ± 3.69, p lt; 0.05) and septal thickness (9.45 ± 1.13 vs 8.91 ± 1.55, p lt; 0.05) increased left Room posterior wall thickness (the posterior wall of left ventricle, LVPW) (9.05 ± 0.94 vs 8.32 ± 1.39, p lt; 0.01) a significant increase in ejection fraction (ejection fraction, EF) (65.63 ± 4.04 vs 68.95 ± 7.33, p lt; 0.01) and diastolic mitral valve early and late peak velocity ratio (the maximum blood flow 'velocity ratio of mitral valve orifice in. early and late diastolic V_E / V_A) (1.03 ± 0.32 vs 1.35 ± 0.45, p lt; 0.01) is significantly reduced. RA patients with EF value and ESR (r = -0.290, p = 0.023), RF (r = -0.335, p = 0.01) was negatively related; V_E / V_A value with the course of the disease (r = -0.312, p = 0.017) anti-CCP antibody (r = -0.334, p = 0.041) were negatively correlated. Neck vascular ultrasound results showed that 52.17% of the incidence of atherosclerosis in RA group (36/69 cases), which early carotid sclerosis 19 cases (M-IMT ≥ 0.85mm) carotid atherosclerotic plaque formation 17 cases (M-IMT gt; 1.3mm); 15.79% (12/76 cases) of the incidence of atherosclerosis in the normal control group, the difference was statistically significant (X to 2 = 21.62, p lt; 0.01) . 5. RA patients with M-IMT values ??increased significantly compared with the control group (0.95 ± 0.17 vs 0.85 ± 0.15, p lt; 0.01), and age (r = 0.568, p = 0.000), RF (r = 0.264, p = 0.045) was positively related; the RA condition with mild, moderate, severe activity group M-IMT value were 0.80 ± 0.22,0.92 ± 0.11,1.04 ± 0.13mm, analysis of variance showed M-IMT values ??among the three groups was significant statistical difference significance (F = 11.247, p = 0.000). 6. RA merger AS group (n = 30), MIF levels were significantly higher RA AS group (n = 30) and NC group (n = 64), (15.25 ± 1.72 vs 13.82 ± 2.19 vs 8.01 ± 2.87, p lt; 0.05);, and M-IMT values ??(r = 0.271, p = 0.036), plaque size (r = 0.291, p = 0.024), IL-17 (r = 0.328, p = 0.007) and IL-23 levels ( r = 0.316, p = 0.010) were positively correlated. RA serum IL-17, IL-23 levels between the AS group and AS group difference was not statistically significant (2.83 ± 2.03 vs 2.52 ± 1.28,448.74 ± 173.66 vs 380.07 ± 136.95, p gt; 0.05 ), but higher than the NC group (p lt; 0.05). 8. Logistic regression analysis showed that the RA serum MIF the CRP and RA28 joint disease activity score (disease activity score in 28 joints, DAS28) risk factors for is its occurrence athero sclerosis. Conclusion RA patients with atherosclerosis and heart attack incidence was significantly higher than the normal control group. 2. RA merger atherosclerosis serum MIF levels were significantly increased and IL-17, IL-23 levels are closely related. Serum the MIF, CRP levels and DAS28 integral may be risk factors for atherosclerosis in patients with RA. Inflammatory factors and autoantibodies in RA may merge played an important role in cardiovascular lesions.
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