类风湿性关节炎中心力衰竭亚型的风险和时间趋势
Tate M Johnson1, Yangyuna Yang2, Punyasha Roul2
1VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA; Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, USA.
Seminars in arthritis and rheumatism
|August 22, 2025
概括
风湿性关节炎 (RA) 显著增加心力衰竭 (HF) 的风险,尤其是心力衰竭与保留射出分数 (HFpEF) 的风险. 尽管治疗进展,但 RA 患者的 HF 风险并没有随着时间的推移而改善.
科学领域:
- 心脏病学
- 关节病学
- 公共卫生
背景情况:
- 类风湿性关节炎 (RA) 是一种慢性炎症性疾病,与心血管疾病的增加有关.
- 心力衰竭 (HF) 是一个显著的并发症,对心力衰竭具有保存的喷射分数 (HFpEF) 和心力衰竭具有减少的喷射分数 (HFrEF) 具有明显的风险.
研究的目的:
- 评估与非RA对照患者的HFpEF和HFrEF风险和时间趋势.
- 在RA群体中确定影响HF风险的因素.
主要方法:
- 使用退伍军人卫生管理局数据 (2000 - 2019) 进行的回顾性,匹配的队列研究.
- 根据年龄,性别和注册年份,RA患者与非RA对照进行了匹配.
- 使用左心室喷射分数数据对HF和与HF相关的死亡事件进行分类;通过考克斯回归评估HF风险,对混因素进行调整.
- 通过分层 RA 诊断期来分析时间趋势.
主要成果:
- 关联于HFpEF (aHR 1.51) 和HFrEF (aHR 1.34) 的风险增加,以及与之相关的死亡.
- 在炎症升高和血清阳性RA患者中,HF风险较高.
- 在研究期间 (2000 - 2017年) 没有观察到HF风险的显著改善.
结论:
- 风湿性关节炎对心力衰竭,特别是HFpEF的风险很大,没有减轻.
- 目前的RA治疗进展并没有降低HF风险.
- 为了制定针对 RA 患者的 HF 预防和治疗策略,进一步的研究至关重要.
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