强直性脊柱炎患者发生动脉管壁炎症的风险增加

作者：van der Valk FM 翻译：张璐

摘要：背景：强直性脊柱炎（AS）是一种慢性炎症性疾病，以中轴和骶髂关节受累为特点。此外，患者的心血管疾病的风险增加（CVD），可能由动脉壁的炎症活动增强引起。在本研究中，我们使用18F-脱氧葡萄糖（FDG）PET-CT(正电子发射断层显像和CT)，比较了与健康对照组患者的颈动脉炎症水平。他汀类药物治疗可减少动脉壁炎症，我们随后评估了3个月的他汀类药物治疗在AS中对动脉壁炎症的作用。

方法及结果：我们纳入24名无心血管疾病史患者（年龄44至10岁，72%名男性），和20名年龄和性别匹配的对照组。AS患者与对照组相比，高密度脂蛋白胆固醇较低而C-反应蛋白增高。两组10年心血管疾病风险均为2%。尽管如此，AS患者在动脉壁的18F-FDG摄取与对照组相比增加20%。3个月每日40毫克阿托伐他汀，可显著降低低密度脂蛋白胆固醇和CRP，随之降低颈动脉壁的炎症反应。

结论：无其他心血管疾病危险因素的AS患者有动脉壁炎症增加的风险，他汀类药物治疗可减少此类情况发生。当前心血管风险血管预防指南并不认为此类受试者具有相关风险。我们的数据提示，AS患者的心血管疾病的管理有改进的需要，并且支持早期他汀类药物治疗可能有效。

附原文：Abstract BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease with involvement of axial and sacroiliac joints. In addition, patients with AS have increased risk of cardiovascular disease (CVD), which might be attributed to enhanced inflammatory activity of the arterial wall. In the present study, we compared the level of carotid arterial wall inflammation in patients with AS with healthy controls using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with CT. As arterial wall inflammation is reduced by statin therapy, we subsequently assessed the effect of 3-month statin therapy on arterial wall inflammation in AS.METHODS AND RESULTS: We included 24 patients with AS (age 44±10, 72% males) without a history of CVD and 20 controls matched for age and gender. Patients with AS had lower high-density lipoprotein cholesterol and increased C reactive protein (CRP) compared with controls. The 10-year CVD risk was 2% in both groups. Notwithstanding, patients with AS had a 20% increase in arterial wall 18F-FDG uptake compared with controls. Three-month atorvastatin 40?mg daily significantly lowered low-density lipoprotein cholesterol (baseline 3.55±1.15?mmol/L, -53%) and CRP (baseline 5.0 (1.5-9.3) mg/L, -58%) with a concomitant decrease of carotid arterial wall inflammation (maximum target-to-background ratio from 1.90±0.30 to 1.67±0.27; p=0.009).CONCLUSIONS: Patients with AS and without other CVD risk factors have increased arterial wall inflammation, which decreases upon statin therapy. These subjects are not identified as being at risk in current cardiovascular prevention guidelines. Our data support the need to revise CV disease management in AS, with perhaps a role for early statin therapy.

引自：van der Valk FM, Bernelot Moens SJ,, Verweij SL et al,Increased arterial wall inflammation in patients with ankylosing spondylitis is reduced by statin therapy[J].Ann Rheum Dis. 2016 Apr 15. pii: annrheumdis-2016-209176. doi: 10.1136