2024 年第 6 期 第 0 卷

血清抗核抗体阳性对大动脉炎患者冠状动脉病变风险的影响

Effect of positive serum anti-nuclear antibody on the risk of coronary artery disease in patients with Takayasu arteritis

作者：廖华杜娟潘丽丽

英文作者：Liao Hua Du Juan Pan Lili

单位：首都医科大学附属北京安贞医院风湿免疫科，北京100029

英文单位：Department of Rheumatology and Immunology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：大动脉炎；抗核抗体；冠状动脉病变

英文关键词：Takayasuarteritis；Anti-nuclearantibodies；Coronaryarterydisease

• 摘要：

• 目的 探讨大动脉炎患者中抗核抗体阳性的临床意义及对患者冠状动脉病变风险的影响。方法 纳入首都医科大学附属北京安贞医院2014年1月至2022年2月住院的大动脉炎且无其他免疫疾病的患者158例。根据抗核抗体检测结果，分为抗核抗体阳性组（46例）和抗核抗体阴性组（112例）。收集研究对象的一般资料、实验室检查和影像学资料，并进行组间相关分析。采用Logistic回归方法分析相关危险因素，并进行预测模型的建立；采用受试者工作特征(ROC)曲线进行不同预测模型曲线下面积(AUC)的比较，分析大动脉炎患者抗核抗体阳性的临床意义。结果 抗核抗体阳性组的高脂血症病史发生率高于抗核抗体阴性组［23.9%(11/46)比7.1%(8/112)］（P=0.003）。抗核抗体阳性组冠状动脉病变发生率明显高于抗核抗体阴性组［50.0%(23/46)比22.3%(25/112)］（P=0.001）。多因素Logistic回归分析显示，抗核抗体阳性和高脂血症是大动脉炎患者冠状动脉病变的独立危险因素（均P＜0.05）。建立大动脉炎冠状动脉病变的预测模型，ROC曲线分析显示，以发病年龄、性别、病程、体重指数、美国国立卫生研究院(NIH)评分和高脂血症病史为基础的模型AUC为0.713（P=0.001），而加入抗核抗体阳性作为危险因素后预测模型AUC提高至0.761（P＜0.001）。针对无高脂血症病史的患者（139例），基于多因素Logistic回归分析构建预测模型，包括发病年龄、性别、病程、体重指数、NIH评分的基线模型AUC为0.645(P=0.046)，而加入抗核抗体阳性作为危险因素后，AUC提高至0.709(P=0.004)。结论 大动脉炎患者合并抗核抗体阳性时需警惕冠状动脉病变，尤其是在既往无高脂血症的患者中，更具有临床提示意义。

• Objective To investigate the clinical significance of positive anti-nuclear antibody (ANA) in patients with Takayasu arteritis (TA) and its impact on the risk of coronary artery disease. Methods A total of 158 patients with TA and without other immune diseases who were hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 2014 to February 2022 were enrolled. According to the results of ANA, the patients were divided into ANA positive group (46 cases) and ANA negative group (112 cases). The general data, laboratory examination and imaging data of the subjects were collected, and the correlation analysis between the groups was performed. Logistic regression method was used to analyze the related risk factors, and the prediction model was established. Receiver operating characteristic (ROC) curve was used to compare the area under the curve (AUC) of different prediction models, and the clinical significance of positive ANA in patients with TA was analyzed. Results The incidence of hyperlipidemia was higher in ANA positive group than in ANA negative group ［23.9%(11/46) vs 7.1%(8/112)］（P=0.003）. The incidence of coronary artery lesions in ANA positive group was significantly higher than that in ANA negative group ［50.0%(23/46) vs 22.3%(25/112)］ (P=0.001). Multivariate Logistic regression analysis showed that positive ANA and hyperlipidemia were independent risk factors for coronary artery lesions in patients with TA (both P＜0.05). The ROC curve analysis showed that the AUC of the model based on age of onset, gender, course of disease, body mass index, National Institutes of Health (NIH) score and hyperlipidemia history was 0.713 (P=0.001), and the AUC of the prediction model increased to 0.761 when ANA was added as a risk factor (P＜0.001). For patients without a history of hyperlipidemia (139 cases), the prediction model was constructed based on multivariate Logistic regression analysis, including age, gender, course of disease, body mass index and NIH score, and the AUC of the baseline model was 0.645 (P=0.046), and the AUC increased to 0.709 when positive ANA was added as a risk factor (P=0.004). Conclusion Coronary artery disease should be alert to patients with TA combined with positive ANA, especially in patients without hyperlipidemia.