与代谢功能障碍相关的脂肪性肝病和类风湿性关节炎中的心血管风险因素
A N Saidi1,2, W B Theel3,4,5, B Burggraaf4
1Department of Internal Medicine, Centre of Endocrinology, Diabetes and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands. a.saidi@franciscus.nl.
Clinical rheumatology
|February 17, 2025
概括
通过Fibrosis-4指数识别的风湿性关节炎肝纤维化患者表现出心血管风险因素的增加. 通过FIB-4早期检测可以指导密集的心血管管理策略.
科学领域:
- 心脏病学 心脏病学
- 肝病学 肝病学是一种肝病学.
- 类风湿病学 类风湿病学
背景情况:
- 类风湿性关节炎 (RA) 是一种慢性自身免疫性疾病,与代谢功能障碍相关的脂肪性肝病 (MASLD) 相关.
- 在RA患者中,MASLD可能会加剧心血管 (CV) 风险.
- 评估肝纤维化对于对RA中心血管风险进行分层至关重要.
研究的目的:
- 调查由纤维化-4 (FIB-4) 指数量化的肝纤维化与 RA 患者心血管风险因素之间的关联.
- 评估FIB-4,亚临床动脉样硬化 (通过心动脉内膜介质厚度 (cIMT) 测量) 和在RA中使用药物的关系.
- 确定FIB-4是否可以识别需要加强心血管风险管理的RA患者.
主要方法:
- 来自FRANCIS (弗朗西斯克风湿关节炎和心血管干预研究) 队列的横截面数据的分析.
- 使用FIB-4指数评估的肝纤维化,值≥1.3,表明纤维化风险高.
- 评估心血管风险因素,药物使用和亚临床动脉样硬化 (cIMT).
主要成果:
- 患有高FIB-4 (n=49) 的患者表现出显著更高的cIMT (p=0.002),阿波利波蛋白B48 (p=0.04),缩血压 (p=0.007) 和性酸酶 (p=0.002).
- 高FIB-4与较低的白细胞计数和补充成分3相关.
- 立方体使用与较高的FIB-4 (OR=4.49,p=0.014) 相关,而氧化 (HCQ) 使用与较低的FIB-4 (OR=0.11,p=0.004) 相关.
结论:
- 在RA患者中FIB-4升高与亚临床动脉样硬化 (cIMT),高血压和动脉样残留积累的增加相关.
- 常规的FIB-4评估可以识别具有高CV风险的RA患者,以便针对性干预.
- 氧化可能对RA患者的肝纤维化发展产生保护作用.
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