Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus
Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus
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DOI：
10.1136/ard.62.11.1071
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发表时间：
2003-11-01
影响因子：
27.4
通讯作者：
Pauletto, P
中科院分区：
文献类型：
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作者：
Doria, A;Shoenfeld, Y;Pauletto, P
目的：目的：探讨系统性红斑狼疮（SLE）临床下动脉粥样硬化的传统和非传统危险因素。SLE的临床和实验室参数，疾病活动和损害，治疗和动脉粥样硬化的传统危险因素进行了评估。在基线（T1）和5年随访（T2）后，检测血清抗氧化棕榈酰花生四烯酸磷酸胆碱（oxPAPC）、抗热休克蛋白65、抗β 2-糖蛋白I抗体和C反应蛋白水平。在T2时，使用颈动脉双功超声测量内膜中层厚度（IMT）。结果：78例患者中有22例（28%）内膜增厚，13例（17%）有斑块形成。平均值（SD）分别为0.77（0.34）mm和0.55（0.15）mm。颈动脉异常的患者明显比无任何病变的患者年龄大，血压和血清总胆固醇水平高，并且服用了更高的泼尼松累积剂量。颈动脉异常与T1时肾脏疾病和ECLAM >2以及硫唑嘌呤治疗相关。在多变量分析中，年龄和累积泼尼松剂量与颈动脉异常;年龄，高血压，抗oxPAPC在T2与较高的M-IMT和m-IMT。结论：在SLE患者中，确定了一些非传统的动脉粥样硬化的危险因素，其中最重要的是累积泼尼松剂量。一些传统的危险因素，如年龄和高血压，也被证实的作用。新的免疫学和炎症标志物对动脉粥样硬化的预测价值似乎被一些疾病相关特征所掩盖。
Objective: To evaluate traditional and non-traditional risk factors for subdinical atherosclerosis in systemic lupus erythematosus (SLE).Methods: A prospective cohort of 78 patients with SLE without overt atherosclerotic disease was studied. SLE clinical and laboratory parameters, disease activity and damage, treatment and traditional risk factors for atherosclerosis were evaluated. At baseline (T1) and after five years' follow up (T2), the serum levels of anti-oxidised palmitoyl arachidonoyl phosphocholine (oxPAPC) anti-heat shock protein 65, and anti-beta(2)-glycoprotein I antibodies and C reactive protein were tested. At T2, intima-media thickness (IMT) was measured using duplex carotid sonography. Thickened intima, plaque, mean IMT (m-IMT), and maximum IMT (M-IMT) were assessed.Results: A thickened intima was seen in 22/78 (28%) patients and plaque in 13/78 (17%). M-IMT and m-IMT were (mean (SD)) 0.77 (0.34) mm and 0.55 (0.15) mm, respectively. Patients with carotid abnormalities were significantly older, had higher blood pressure and total serum cholesterol levels, and had taken a higher prednisone cumulative dosage than those without any lesions. The carotid abnormalities were associated with renal disease and ECLAM >2 at T1, and with azathioprine treatment. In multivariate analysis, age and cumulative prednisone dose were associated with carotid abnormalities; age, hypertension, and anti-oxPAPC at T2 were correlated with higher M-IMT and m-IMT.Conclusions: In patients with SLE some non-traditional risk factors for atherosclerosis were identified, the most important of which was the cumulative prednisone dose. The role of some traditional risk factors, such as age and hypertension, was also confirmed. The predictive value of the new immunological and inflammatory markers of atherosclerosis seems to be masked by some disease related features.