Dyslipidemia in systemic lupus erythematosus
Dyslipidemia in systemic lupus erythematosus
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DOI：
10.1007/s12026-016-8892-9
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发表时间：
2017-04-01
影响因子：
4.4
通讯作者：
Kiss, Emese
中科院分区：
文献类型：
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作者：
Szabo, Melinda Zsuzsanna;Szodoray, Peter;Kiss, Emese
心血管疾病是系统性红斑狼疮(SLE)患者发病和死亡的主要原因之一。动脉粥样硬化的加速与传统的(年龄、高血压、糖尿病、血脂异常、肥胖、吸烟和阳性家族史)和非传统的疾病相关因素有关。传统的危险因素在狼疮患者中仍然更为突出，因为在几个SLE队列中，高血压和高胆固醇血症都与过早的动脉粥样硬化独立相关。在这项工作中，作者总结了狼疮患者血脂异常的流行病学，并综述了血脂异常发病机制的最新结果。血脂异常的患病率在诊断SLE时约为30%，3年后上升至60%，总胆固醇(TC)、低密度脂蛋白(LDL)、甘油三酯(TG)和载脂蛋白B(ApoB)升高，低密度脂蛋白(LDL)水平下降。包括多种致病机制，C反应蛋白(CRP)和血沉(ESR)可抑制高密度脂蛋白(HDL)而升高甘油三酯(TG)，自身抗体可导致内皮损伤，脂蛋白脂酶(LPL)活性可被循环中的炎症介质和抗体降低，氧化应激增加可能引发广泛的促动脉粥样硬化脂质修饰。作为一个主要的危险因素，血脂异常应积极治疗，以最大限度地减少动脉粥样硬化和心血管事件的风险。使用他汀类药物的随机对照试验在延缓动脉粥样硬化进展方面存在争议，但通过抑制动脉壁的免疫激活和减少狼疮活动可能是有利的。
Cardiovascular disease is one of the major causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Accelerated atherosclerosis is related to traditional (age, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, and positive family history) and non-traditional, disease-related factors. Traditional risk factors are still more prominent in patients with lupus, as both hypertension and hypercholesterinemia were independently associated with premature atherosclerosis in several SLE cohorts. In this work, the authors summarize the epidemiology of dyslipidemia in lupus patients and review the latest results in the pathogenesis of lipid abnormalities. The prevalence of dyslipidemia, with elevations in total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (TG), and apolipoprotein B (ApoB), and a reduction in low-density lipoprotein (LDL) levels are about 30% at the diagnosis of SLE rising to 60% after 3 years. Multiple pathogenetic mechanism is included, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can suppress HDL and increase TG, auto-antibodies can cause the injury of the endothelium, lipoprotein lipase (LPL) activity can be reduced by circulating inflammatory mediators and antibodies, and increased oxidative stress may trigger a wide range of pro-atherogenic lipid modifications. As a major risk factor, dyslipidemia should be treated aggressively to minimize the risk of atherosclerosis and cardiovascular events. Randomized controlled trials with statins are controversial in the detention of atherosclerosis progression, but can be favorable by inhibiting immune activation that is the arterial wall and by decreasing lupus activity.