| Objective:To analyze the correlation between carotid artery ultrasound and indicators of clinical and laboratory in patients with rheumatoid arthritis(RA),and to explore the impaired causes of carotid artery structure and function in RA patients.To find clinical indicators that can effectively predict the occurrence of carotid atherosclerosis plaque and the increase of arterial stiffness in RA patients.Methods:56 RA patients diagnosed in the department of rheumatology and immunology of our hospital from October 2018 to December 2020 were selected as the RA group,and 50 healthy people in the physical examination center of our hospital were selected concurrently as the control group.Collected the general information and blood lipid indexes of all the enrolled individuals,and recorded the smoking history,blood pressure and body mass index(BMI).Two-dimensional and Doppler ultrasound were used to measure the carotid intima-media thickness(c IMT)and whether there is a neck arterial plaque and the pulse wave velocity(PWV).The RA patients were divided into carotid atherosclerotic plaque(CAP)group and non-carotid atherosclerotic plaque(NCAP)group according to the ultrasound performance of c IMT.Collected the laboratory indicators including erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),anti-cyclic citrullinated peptide antibody(Anti-CCP),rheumatoid factor(RF),and interleukin-6(IL-6)of the two groups.Asked disease duration of RA patients,and evaluated the disease activity score(DAS28-CRP,DAS28-ESR).SPSS26.0 statistical software was used to compare the differences in general data,c IMT,the occurrence rate of carotid plaque,and PWV between the RA group and the control group.Compared the differences in general data,laboratory indicators,disease activity,and disease duration between the CAP group and the NCAP group.The multivariate Logistic regression method was used to analyze the risk factors of carotid plaque in RA,and the receiver operating characteristic curve was drawn(ROC)to evaluate the predictive power of each risk factor.Pearson or Spearman correlation analysis was performed between PWV and various clinical indicators in the RA group,and a multiple linear regression model was established to find the risk factors that affect PWV in RA patients.Bland-Altman method was used to detect the repeatability of the value of PWV.Results:(1)The c IMT,carotid plaque incidence and PWV in the RA group were 0.84(0.63～1.16)mm,32.14%,(9.81±2.32)m/s respectively,which were all higher than those in the control group with 0.64(0.57～0.71)mm,8.00%,(7.19±1.27)m/s respectively(P<0.05).(2)The level of IL-6 and disease duration in the CAP group of RA patients were(32.89±25.72)pg/ml,(28.50±17.57)months respectively,which were all higher than those in the NCAP group with(13.74±10.61)pg/ml,(16.45±13.96)months respectively(P<0.05).(3)Multivariate logistic regression analysis showed that elevated IL-6[OR(95%CI):1.090(1.029～1.155)] and longer disease duration[OR(95%CI):1.057(1.012～1.104)] were independent risk factors of the carotid plaque in RA patients(P<0.05).(4)ROC curve results showed that the area under the curve(AUC)of the level of IL-6 and disease duration predict carotid plaque in RA patients were 0.795(95%CI: 0.655～0.935)and 0.710(95%CI: 0.559～0.861)respectively(P<0.05).The best cut-off values for predicting carotid plaque in RA patients with IL-6 level and disease duration were 19.48pg/ml and 32months(P<0.05),and IL-6>19.48pg/ml and disease duration>32 months were independent risk factors for carotid plaque.(5)Pearson or Spearman correlation analysis showed that the correlation coefficients between PWV and CRP,Anti-CCP,IL-6,DAS28-CRP in RA patients were 0.358,0.330,0.361,0.284respectively(P<0.05),and the correlation coefficient between IL-6 and PWV was the highest.(6)A multiple linear regression model was established with PWV as the dependent variable,and the results showed that Anti-CCP[B(95%CI):0.004(0.002～0.006)] and IL-6[B(95%CI):0.036(0.009～0.063)]were independent risk factors for increased PWV in RA patients(P<0.05).The Bland-Altman method showed that the value of PWV has good repeatability between inter observers and intra observers.Conclusions:1.RA patients are more likely to have carotid plaque and increase in PWV than healthy people,and more likely to have damage in structure and function of the carotid artery.2.IL-6>19.48pg/ml and the course of disease>32 months are independent risk factors for carotid plaques in RA patients.And the levels of IL-6 are more effective than disease duration.3.IL-6 and Anti-CCP are independent risk factors for the increase of arterial stiffness in RA patients. |
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