痛风性关节炎血管内皮功能及其与血尿酸水平的相关性

doi:10.3969/j.issn.1004-583X.2023.03.008

摘要/Abstract

摘要：

目的利用超声评估痛风性关节炎( gouty arthritis,GA)患者血管内皮功能是否受损,以及其与血尿酸(serum urate,SUA)水平的相关性。方法选取GA患者45例及对照组35例,记录SUA、高密度脂蛋白胆固醇(high density lipoprotein,HDL)、低密度脂蛋白胆固醇(low-density lipoprotein,LDL)、总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、C反应蛋白(C-reactive protein, CRP)、血沉(erythrocyte sedimentation rate,ESR)等实验室数据,以及身高、体重、身体质量指数(body mass index,BMI)、病程;超声测量右侧颈总动脉内-中膜厚度(carotid intima media thickness,CIMT)、右上肢肱动脉内皮依赖性舒张功能(flow-mediated dilation,FMD)。对比GA组与对照组差异,分析GA组FMD与SUA及其他变量相关性。结果 GA组BMI、SUA、ESR、CRP、TC、TG、LDL均较对照组高,FMD较对照组明显减低,差异具有统计学意义( $P$ <0.05),GA组FMD与SUA、CRP、CIMT及病程呈负相关( $r$ =-0.393、 -0.322、-0.458、-0.431)。结论 GA可能会引起患者血管内皮功能受损,与SUA、CRP及病程具有一定相关性,超声可评估GA患者血管内皮功能,对临床治疗改善血管内皮功能、预防心血管疾病具有重要价值。

关键词: 关节炎,痛风性, 血管舒张, 尿酸, 超声检查

Abstract:

Objective To explore the effect of ultrasound (US) on the impairment of vascular endothelial function (VEF) in patients with gouty arthritis (GA) and its correlation with serum uric acid (SUA) levels.Methods This study included 45 GA patients (the GA group) and 35 healthy subjects (the control group). The key observation was laboratory data (SUA, high density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [TC], triglycerides [TG], C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), height, weight, body mass index (BMI), disease duration. The right carotid intima media thickness (CIMT), flow-mediated dilation (FMD) of right upper limb were measured by US between GA group and control group. The correlation between FMD and SUA, other variables in the GA group was analyzed.Results Compared with the control group, BMI, SUA, ESR, CRP, TC, TG, LDL in the GA group were significantly increased, while FMD was significantly decreased (P<0.05). FMD was negatively correlated with SUA, CRP, CIMT and disease duration in GA group ( $r$ =-0.393, -0.322, -0.458, -0.431). Conclusion GA can cause damage to VEF in patients, which is related to SUA, CRP and the disease duration. US can evaluate VEF, which is of great value in the prevention of cardiovascular diseases.

Key words: gouty arthritis, vasodilation, uric acid, ultrasonic examination

中图分类号:

R684.3

沈雪娇, 李燕, 王挺, 王媛. 痛风性关节炎血管内皮功能及其与血尿酸水平的相关性[J]. 临床荟萃, 2023, 38(3): 241-244.

Shen Xuejiao, Li Yan, Wang Ting, Wang Yuan. Correlation between vascular endothelial function and serum uric acid in gouty arthritis[J]. Clinical Focus, 2023, 38(3): 241-244.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.008

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/241

图/表 4

表1 两组临床和实验室数值比较( x -±s)

Tab.1 Comparison of clinical and laboratory values between the two groups ( x -±s)

组别	例数		病程 (年)		BMI (kg/m²)		SUA (μmol/L)		ESR (mm/h)	CRP (mg/L)	TC (mmol/L)
GA组	45		4.91±4.76		27.30±3.80		520.71±113.23		11.72±13.64	10.29±17.23	4.12±0.79
对照组	35		-		23.05±1.81		313.54±87.57		3.40±0.64	1.47±0.62	3.87±0.63
$t$ 值			-		-6.130		-8.940		-2.200	-2.990	-4.400
$P$ 值			-		<0.01		<0.01		0.031	<0.01	<0.01
组别		TG (mmol/L)		LDL (mmol/L)		HDL (mmol/L)		SBP (mmHg)		FMD (%)	CIMT (mm)
GA组		1.64±0.88		2.55±0.74		1.19±0.26		117.93±8.46		9.35±2.94	0.69±0.15
对照组		1.25±0.29		2.18±0.48		1.24±0.12		114.51±6.69		13.49±1.02	0.66±0.07
$t$ 值		-2.120		-2.570		0.960		-3.680		7.950	-1.160
$P$ 值		0.043		0.012		0.339		0.214		<0.01	0.249

表1 两组临床和实验室数值比较( x -±s)

Tab.1 Comparison of clinical and laboratory values between the two groups ( x -±s)

组别	例数		病程 (年)		BMI (kg/m²)		SUA (μmol/L)		ESR (mm/h)	CRP (mg/L)	TC (mmol/L)
GA组	45		4.91±4.76		27.30±3.80		520.71±113.23		11.72±13.64	10.29±17.23	4.12±0.79
对照组	35		-		23.05±1.81		313.54±87.57		3.40±0.64	1.47±0.62	3.87±0.63
$t$ 值			-		-6.130		-8.940		-2.200	-2.990	-4.400
$P$ 值			-		<0.01		<0.01		0.031	<0.01	<0.01
组别		TG (mmol/L)		LDL (mmol/L)		HDL (mmol/L)		SBP (mmHg)		FMD (%)	CIMT (mm)
GA组		1.64±0.88		2.55±0.74		1.19±0.26		117.93±8.46		9.35±2.94	0.69±0.15
对照组		1.25±0.29		2.18±0.48		1.24±0.12		114.51±6.69		13.49±1.02	0.66±0.07
$t$ 值		-2.120		-2.570		0.960		-3.680		7.950	-1.160
$P$ 值		0.043		0.012		0.339		0.214		<0.01	0.249

表2 FMD与其他变量相关性分析

Tab.2 Correlation analysis between FMD and other variables

	FMD
	$r$ 值	$P$ 值
BMI(kg/m²)	-0.158	0.300
SUA(μmol/L)	-0.393	0.007
ESR(mm/h)	-0.219	0.149
CRP(mg/L)	-0.322	0.030
TC(mmol/L)	0.273	0.069
TG(mmol/L)	-0.180	0.238
LDL(mmol/L)	0.124	0.416
HDL(mmol/L)	0.224	0.139
SBP(mmHg)	-0.242	0.109
CIMT(mm)	-0.458	0.001
病程	-0.431	0.003

表2 FMD与其他变量相关性分析

Tab.2 Correlation analysis between FMD and other variables

	FMD
	$r$ 值	$P$ 值
BMI(kg/m²)	-0.158	0.300
SUA(μmol/L)	-0.393	0.007
ESR(mm/h)	-0.219	0.149
CRP(mg/L)	-0.322	0.030
TC(mmol/L)	0.273	0.069
TG(mmol/L)	-0.180	0.238
LDL(mmol/L)	0.124	0.416
HDL(mmol/L)	0.224	0.139
SBP(mmHg)	-0.242	0.109
CIMT(mm)	-0.458	0.001
病程	-0.431	0.003

表3 FMD与SUA回归分析结果

Tab.3 Regression analysis of FMD and SUA

组别		偏回归系数	标准误	标准化偏回归系数	$t$ 值	$P$ 值
GA	常数项	14.677	1.941		7.560	<0.01
	SUA	-0.010	0.004	-0.393	-2.810	0.008

表3 FMD与SUA回归分析结果

Tab.3 Regression analysis of FMD and SUA

组别		偏回归系数	标准误	标准化偏回归系数	$t$ 值	$P$ 值
GA	常数项	14.677	1.941		7.560	<0.01
	SUA	-0.010	0.004	-0.393	-2.810	0.008

图1 FMD与SUA单因素回归性分析

Fig.1 Univariate regression analysis of FMD and SUA

参考文献 22

[1]	Çukurova S, Pamuk ÖN, Ünlü E, et al. Subclinical atherosclerosis in gouty arthritis patients: A comparative study[J]. Rheumatol Int, 2012, 32(6):1769-1773. doi: 10.1007/s00296-011-1900-4 pmid: 21442166
[2]	Choi YJ, Yoon Y, Lee KY, et al. Uric acid induces endothelial dysfunction by vascular insulin resistance associated with the impairment of nitric oxide synthesis[J]. 2014, 28(7): 3197-3204.
[3]	Perez-Ruiz F, Becker MA. Inflammation: A possible mechanism for a causative role of hyperuricemia/gout in cardiovascular disease[J]. Curr Med Res Opin, 2015, 31(Suppl 2): 9-14. doi: 10.1185/03007995.2015.1087980 URL
[4]	李文博, 陈岩, 安松涛, 等. 血管紧张素Ⅱ1型受体基因多态性对动脉硬化影响的Meta分析[J]. 中国动脉硬化杂志, 2019, 27(9):802-807.
[5]	Martín-Martínez MA, González-Juanatey C, Castañeda S, et al. Recommendations for the management of cardiovascular risk in patients with rheumatoid arthritis: Scientific evidence and expert opinion[J]. Semin Arthritis Rheum, 2014, 44(1):1-8. doi: 10.1016/j.semarthrit.2014.01.002 URL
[6]	Arévalo-Lorido JC, Carretero-Gómez J, Robles Pérez-Monteoliva NR. Association between serum uric acid and carotid disease in patients with atherosclerotic acute ischemic stroke[J]. Vascular, 2019, 27(1):19-26. doi: 10.1177/1708538118797551 pmid: 30205779
[7]	Bertolazzi C, Gutierrez M, Espinosa R, et al. SAT0613 High prevalence of subclinical atherosclerosis in gout and asymptomatic hyperuricemia: A study based on carotid ultrasound[J]. Ann Rheum Dis, 2017, 76(Suppl 2):6363.
[8]	Gancheva R, Kundurdjiev A, Nikolova G, et al. Serum oxidative stress markers are not associated with renal and common carotid arteries arteriosclerotic vascular changes in patients with gout[J]. Acta Med Bulgarica, 2019, 46(3):37-43.
[9]	Gancheva R, Kundurdjiev A, Ivanova M, et al. Evaluation of cardiovascular risk in stages of gout by a complex multimodal ultrasonography[J]. Rheumatol Int, 2017, 37(1):121-130. doi: 10.1007/s00296-016-3556-6 pmid: 27577941
[10]	Toyoda S, Tokoi S, Takekawa H, et al. Relationship between brachial flow-mediated dilation and carotid intima-media thickness in patients with coronary artery disease[J]. Int Angiol, 2020, 39(5):433-442.
[11]	Pacholczak-Madej R, Kuszmiersz P, Bazan-Socha S, et al. Endothelial dysfunction in patients with systemic sclerosis[J]. Postepy Dermatol Alergol, 2020, 37(4):495-502.
[12]	Krasnokutsky S, Romero AG, Bang D, et al. Impaired arterial responsiveness in untreated gout patients compared with healthy non-gout controls: Association with serum urate and C-reactive protein[J]. Clin Rheumatol, 2018, 37(7):1903-1911. doi: 10.1007/s10067-018-4029-y pmid: 29450849
[13]	尤杨, 戚国庆, 高宏阳, 等. 匹伐他汀对高尿酸血症大鼠血尿酸、炎症因子、血管内皮功能的影响[J]. 中国免疫学杂志, 2020, 36(19):2361-2365.
[14]	Komori H, Yamada K, Tamai I. Hyperuricemia enhances intracellular urate accumulation via down-regulation of cell-surface BCRPABCG2 expression in vascular endothelial cells[J]. Biochim Biophys Acta Biomembr, 2018, 1860(5):973-980. doi: 10.1016/j.bbamem.2018.01.006 URL
[15]	Apraş Bilgen Ş, Kalyoncu U, Erden A, et al. Assessment of subclinical atherosclerosis in psoriatic arthritis patients without clinically overt cardiovascular disease or traditional atherosclerosis risk factors[J]. Turk Kardiyol Dern Ars, 2018, 46(5):358-365. doi: 10.5543/tkda.2018.36169 pmid: 30024392
[16]	Neogi T, Jansen TL, Dalbeth N, et al. 2015 gout classification criteria: An american college of rheumatology european league against rheumatism collaborative initiative[J]. Arthritis Rheumatol, 2015, 67(10):2557-2568. doi: 10.1002/art.39254 URL
[17]	Mónica FZ, Bian K, Murad F. The endothelium-dependent nitric oxide-cGMP pathway[J]. Adv Pharmacol, 2016, 77:1-27.
[18]	王飞, 郑雅朦, 吴言, 等. 新型超声评分法评估痛风性关节炎的可行性研究[J]. 中国超声医学杂志, 2019, 35(7):650-652.
[19]	Toprover M, Shah B, Oh C, et al. Initiating guideline-concordant gout treatment improves arterial endothelial function and reduces intercritical inflammation: A prospective observational study[J]. Arthritis Res Ther, 2020, 22(1):169. doi: 10.1186/s13075-020-02260-6 pmid: 32653044
[20]	李红艳, 秦历杰, 李静宇, 等. 降尿酸治疗对脑梗死患者血管内皮功能的影响[J]. 中华急诊医学杂志, 2021, 30(6):744-748.
[21]	Abhishek A, Valdes AM, Zhang W, et al. Association of serum uric acid and disease duration with frequent gout attacks:A case-control study[J]. Arthritis Care Res(Hoboken), 2016, 68(10):1573-1577.
[22]	Zou Z, Yang M, Wang Y, et al. Association of urate deposition shown by ultrasound and frequent gout attacks[J]. Z Rheumatol, 2021, 80(6):565-569. doi: 10.1007/s00393-020-00913-0 pmid: 33034681