中医证型与类风湿关节炎相关动脉粥样硬化事件的关联性分析OA

Objective To investigate the risk factors for atherosclerosis(AS)in rheumatoid arthritis(RA)patients and its correlation with traditional Chinese medicine(TCM)syndromes.Methods A cross-sectional study was conducted,enrolling 16,082 RA patients from 122 medical centers nationwide.Patient demographics,dis-ease assessment data including disease activity(DAS-28),tender joint count(TJC),swollen joint count(SJC),patient's global assessment(PGA),evaluator's global assessment(EGA),and visual analogue scale(VAS),major clinical symptoms including insomnia,loss of appetite,irritability,and fatigue,and laboratory indicators including blood routine,inflammatory markers,liver and kidney function,metabolic indices,and coagulation markers were collected through questionnaire.Based on the four examinations in TCM,patients were classified into eight TCM syn-dromes,which were wind-damp obstruction,cold-damp obstruction,damp-heat obstruction,phlegm-stasis obstruc-tion,blood stasis obstructing the collaterals,qi-blood deficiency,liver-kidney insufficiency,and qi-yin deficiency.Patients who experienced AS events were included in the event group(564 cases),while those without AS events were included in the non-event group(15,518 cases).Intergroup difference tests were used to screen potential risk factors,and binary logistic regression analysis was employed to assess the correlation between TCM syndromes and rheuma-toid arthritis with atherosclerosis(RA-AS).Results Compared to the non-event group,patients in the event group had longer disease duration,higher body weight,and older age(P＜0.05),and showed significantly higher DAS28,TJC,SJC,PGA,EGA,VAS,ESR,low-density lipoprotein cholesterol(LDL-C),triglycerides(TG),total cholesterol(TC),and D-dimer levels,and lower high-density lipoprotein cholesterol(HDL-C),with more severe symptoms of insomnia,irritability,and fatigue(P＜0.05).Damp-heat obstruction syndrome was the most prevalent in both groups,with a higher proportion in the event group(393/564,69.68％)than in the non-event group(4578/15,518,29.50％)showing significant difference(P＜0.05).Logistic regression analysis showed that patients with damp-heat obstruction syndrome had a 5.326-fold higher risk of developing RA-AS compared to those without this syn-drome(OR=5.326,95％CI 4.517 to 7.089,P＜O.001).Conclusion The occurrence of RA-AS is associated with TCM syndromes,disease activity,inflammatory markers and lipid metabolic indices,and damp-heat obstruc-tion syndrome is an independent risk factor for RA-AS.