類風濕性關節炎病人血脂肪分布情況及與發炎指數的關聯性

Conventional Lipid Profiles and Its Relation to Inflammatory Markers in Patients with Rheumatoid Arthritis

Objective: There is little known about the lipid profiles of Taiwanese patients with rheumatoid arthritis (RA). The objective of this study was to compare the conventional serum lipid profiles (total cholesterol [TCH], HDL cholesterol [HDL-C], LDL cholesterol [LDL-C], triglycerides [TG], TCH/HDL-C, and LDL-C/HDL-C) of Taiwanese controls and patients with RA. We also evaluated the association between these lipid profiles with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in RA patients. Method: A total of 212 patients with RA who were receiving treatment and 2120 age- and sex-matched healthy controls were enrolled from 2010 to 2014. Serum lipid profiles were obtained from both groups, and the levels of ESR and CRP were obtained from the RA patients. Results: Relative to controls, RA patients had a significantly higher level of HDL-C (p < 0.001), but significantly lower levels of TCH, LDL-C, TG, TCH/HDL-C, and LDL-C/HDL-C (p < 0.001 for all). Multiple linear regression analyses of RA patients (n = 212) indicated that males had lower levels of HDL-C (p < 0.001), LDL-C (p = 0.048), and TCH (p = 0.009); age was directly associated with TG level (p = 0.006); smoking was directly associated with the levels of TCH/HDL-C (p = 0.001), LDL-C/HDL-C (p = 0.002), and LDL-C (p = 0.066); and ESR was directly associated with the levels of TCH/HDL-C (p = 0.001) and LDL-C/HDL-C (p = 0.004), but inversely associated with the level of HDL-C (p = 0.003). Conclusion: Taiwanese patients with RA tended to have non-atherogenic lipid profiles (high HDL-C, but low LDL-C and TCH/HDL-C) relative to controls. In addition, the ESR level in RA patients was directly associated with the levels of LDL-C/HDL-C and TCH/HDL-C, but inversely associated with the HDL-C level. 目的：過往類風濕性關節炎病患血脂肪組合狀況的研究為數不多，尤其是針對台灣病患的研究。本研究旨在比較類風濕性關節炎病患和正常族群的傳統血脂肪組合狀況，包括總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、三酸甘油脂、總膽固醇／高密度脂蛋白膽固醇比值、低密度脂蛋白膽固醇／高密度脂蛋白膽固醇比值。此外，亦分析血脂肪與發炎指標紅血球沉降速率與C反應蛋白的關聯性。方法：從2010年至2014年，本研究收錄大林慈濟醫院共212位接受治療中的類風濕性關節炎病患，以及2120位以年齡及性別配對的健康對照組，並抽血檢測血脂肪。此外，檢測類風濕性關節炎病患的血球沉降速率與C反應蛋白。結果：類風濕性關節炎病患血液中的高密度脂蛋白膽固醇顯著比對照組為高（p＜0.001）。類風濕性關節炎病患血液總膽固醇、低密度脂蛋白膽固醇、三酸甘油脂、總膽固醇／高密度脂蛋白膽固醇比值、低密度脂蛋白膽固醇／高密度脂蛋白膽固醇比值皆較對照組顯著為低（p＜0.001）。多變項迴歸分析顯示男性與高密度脂蛋白膽固醇（p＜0.001）、低密度脂蛋白膽固醇（p=0.048）和總膽固醇（p=0.009）呈顯著負相關。較大年齡與三酸甘油脂呈顯著正相關（p=0.006）。抽菸與總膽固醇／高密度脂蛋白膽固醇比值（p=0.001）和低密度脂蛋白膽固醇／高密度脂蛋白膽固醇比值（p=0.002）呈顯著正相關，但抽菸和低密度脂蛋白膽固醇有正相關的趨勢（p=0.066）。此外，紅血球沉降速率與總膽固醇／高密度脂蛋白膽固醇比值（p=0.001）和低密度脂蛋白膽固醇／高密度脂蛋白膽固醇比值（p=0.004）呈顯著正相關，但與高密度脂蛋白膽固醇則呈顯著負相關（p=0.003）。結論：相比對照組，類風濕性關節炎病患呈現出非動脈粥樣硬化的血脂組合（較高的高密度脂蛋白膽固醇、較低的低密度脂蛋白膽固醇以及較低的總膽固醇／高密度脂蛋白膽固醇比值）。此外，在類風濕性關節炎病患中，紅血球沉降速率與較高的低密度脂蛋白膽固醇／高密度脂蛋白膽固醇比值和總膽固醇／高密度脂蛋白膽固醇比呈顯著相關，但與高密度脂蛋白膽固醇則呈顯著負相關。