类风湿性关节炎发生房颤的风险不增加

作者:发布时间:2014/5/22 15:56:39
摘要:背景:已有研究表明,系统性炎症在房颤发生中有着重要的作用。众所周知,类风湿性关节炎是一种慢性炎症性疾病,增加了冠心病的风险,但几乎没有证据证明类风湿性关节炎是否增加了房颤的风险。
 方法:使用来自美国大型商业保险计划数据:我们对住院患者中并发房颤的类风湿性关节炎患者与未患类风湿性关节炎的患者进行比较。类风湿性关节炎患者要求有≥2次的独立就诊记录和正在服用≥1种抗风湿病药物。房颤在类风湿性关节炎患者中的发生率也与骨性关节炎慢性非炎症性疾病相比较。 
结论:在20852例类风湿性关节炎患者与104260例非类风湿性关节炎患者中,有相同的年龄、性别和检索日期。2年的跟踪观察,在类风湿性关节炎患者中,每年千人中的患房颤率为4.0(95% CI 3.4 to 4.7),在非类风湿性关节炎患者中为 2.8 (95% CI2.6 to 3.0)。房颤的发生率在类风湿性关节炎与非类风湿性关节炎比为 1.4 (95% CI 1.2 to 1.7) 。在一个多变量Cox的模型中,校正风险因素,如糖尿病、冠心病及药物、医疗保健,类风湿性关节炎患者的房颤发生率较非房颤患者无明显增多。在类风湿性关节炎与骨性关节炎患者中房颤的发病率无明显异常。 
结论:经过校正分析各种合并症,药物与医疗的干预因素,我们的结论显示类风湿性关节炎患者的房颤发病率无增加。
 附原文: Abstract  BACKGROUND: Prior research suggests an important role of systemic inflammation in pathogenesis of atrial fibrillation (AF). It is well known that rheumatoid arthritis (RA), a chronic, systemic inflammatory disorder, increases the risk of cardiovascular disease (CVD), but little evidence exists whether the risk of AF is increased in RA.METHODS: Using data from a large US commercial insurance plan, we examined the incidence rate (IR) of hospitalisation for AF in patients with RA compared with non-RA. RA patients were identified with ≥2 separate visits coded for RA and ≥1 disease-modifying antirheumatic drug dispensing. The IR of AF in RA patients was also compared with those with osteoarthritis, a chronic non-inflammatory condition.RESULTS: There were 20 852 RA and 104 260 non-RA patients, matched on age, sex and index date. The mean follow-up was 2 years. The IR per 1000 person-years of AF was 4.0 (95% CI 3.4 to 4.7) in RA and 2.8 (95% CI 2.6 to 3.0) in non-RA patients. The IR ratio for AF was 1.4 (95% CI 1.2 to 1.7) in RA compared with non-RA patients. In a multivariable Cox model adjusting for a number of risk factors such as diabetes, CVD, medications and healthcare utilisation, the risk of AF was no longer increased in RA (HR 1.1, 95% CI 0.9 to 1.4) compared with non-RA patients. There was also no difference in the AF risk between RA and osteoarthritis patients.CONCLUSIONS: Our results show no increased risk of AF associated with RA, after adjusting for various comorbidities, medications and healthcare use. 
引自: Kim SC1, Liu J, Solomon DH.The risk of atrial fibrillation in patients with rheumatoid arthritis. Ann Rheum Dis. 2014 Jun 1;73(6):1091-5. doi: 10.1136/annrheumdis-2013-203343. Epub 2013 Apr 20.   北医三院海淀医院风湿免疫科  杨群智张舸