2017 年第 12 期 第 12 卷

类风湿关节炎与代谢综合征关系的研究进展

作者：韩佳丽程渝陈聪潘丽丽

英文作者：

单位：100069北京，首都医科大学2013级临床医学专业(韩佳丽、程渝、陈聪)；100029首都医科大学附属北京安贞医院风湿免疫科(潘丽丽)

英文单位：

关键词：关节炎,类风湿；代谢综合征；脂代谢紊乱；胰岛素抵抗；高尿酸血症；脂肪因子

英文关键词：

• 摘要：

• 类风湿关节炎（RA）与代谢综合征各组分关系密切，进而对心血管疾病（CVD）事件的发生产生不利影响。RA患者血脂代谢异常表现为血脂成分的降低，以高密度脂蛋白胆固醇降低尤为显著，呈现出致动脉粥样硬化趋势。尽管RA患者与非RA人群体重指数差异无统计学意义，但RA患者存在脂肪分布的改变以腹型肥胖为主，加重了炎症发展。RA患者的系统炎性状态导致2型糖尿病患病率高于非RA人群，亦导致其CVD的风险增加。RA患者糖代谢异常与胰岛素抵抗的程度以及RA疾病活动度相关。相当多的RA患者关节周围尿酸盐沉积，血尿酸可预测RA患者外周动脉事件。脂肪因子也参与RA炎症、免疫反应，但脂肪因子与RA疾病活动的关系尚存在争议。抗风湿药物甲氨蝶呤、肿瘤坏死因子α拮抗剂及白细胞介素1拮抗剂可改善代谢综合征并降低CVD风险。临床中应重视RA与代谢综合征的关系，并积极对CVD风险进行评估，以减少RA患者心血管并发症的发生，对改善RA患者预后具有极其重要的意义。

• Research progress of relation between rheumatoid arthritis and metabolic syndrome

  Han Jiali, Cheng Yu, Chen Cong, Pan Lili

  Undergraduate of Clinical Medicine Specialty, Grade 2013, Capital Medical University, Beijing 100069, China(Han JL, Cheng Y, Chen C); Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China(Pan LL)

  Corresponding author: Pan Lili, Email: lilypansxmu@sina.com

  【Abstract】Rheumatoid arthritis（RA） is related to metabolic syndrome, which leads to a high risk of cardiovascular diseases（CVD）. Dyslipidemia in patients with RA characterized by lower cholesterols, especially high-density lipoprotein cholesterol, is associated with atherosclerosis. Change of fat distribution and abdominal obesity can aggravate inflammatory response in RA patients. The prevalence rate of type 2 diabetes in RA patients is higher than that in normal population, which also lead to a high risk of CVD. Disorder of glucose metabolism and insulin resistance are related to the activity of RA. Urate deposition around joints is common in RA; the level of blood uric acid can be a predictor of peripheral arterial events. Adipokines play roles in inflammatory and immune reaction in RA; the relevance between adipokines and activity of RA is still under investigation. Antirheumatic drug such as methotrexate, tumor necrosis factor-α antagonist and interleukin-1 antagonist can improve metabolic syndrome and reduce the risk of CVD. The relationship between RA and metabolic syndrome needs attention in clinical practice to prevent cardiovascular events and avoid poor prognosis.

  【Key words】Arthritis, rheumatoid;Metabolic syndrome;Lipid disorders;Insulin resistance;Hyperuricemia;Adipokines

  【Fund program】National Natural Science Foundation of China (81400361); Undergraduate Research Innovation Program of Capital Medical University(XSKY2016161)