Incidence and risk factors of thromboembolism in systemic lupus erythematosus - A comparison of three ethnic groups
Incidence and risk factors of thromboembolism in systemic lupus erythematosus - A comparison of three ethnic groups
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DOI：
10.1002/art.21224
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发表时间：
2005-09-01
影响因子：
--
通讯作者：
Petri, M
中科院分区：
文献类型：
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作者：
Mok, CC;Tang, SSK;Petri, M
Objective.比较不同种族背景的系统性红斑狼疮（SLE）患者血栓栓塞事件的发生率和危险因素。对1996年至2002年间新诊断或确诊后6个月内转诊的SLE患者进行前瞻性随访，以了解血栓栓塞事件的发生情况。对血栓栓塞的累积危险和危险因素进行评估，并在不同种族的患者中进行比较。我们研究了625例符合美国流变学学会SLE标准的患者（89%为女性）：258例中国人，140例非洲裔美国人和227例白人。SLE诊断时的平均± SD年龄为35.7 ± 14岁。在3，094患者年的随访后，83例患者发生了48起动脉事件和40起静脉事件。动脉和静脉血栓栓塞的总发生率分别为16/1，000患者-年和13/1，000患者-年。在中国人、非洲裔美国人和白人中，SLE诊断后60个月动脉事件的累积风险分别为8.5%、8.1%和5.1%。静脉事件的相应累积风险分别为3.7%、6.6%和10.3%（中国人与高加索人的对数秩检验P = 0.008）。吸烟、肥胖、抗磷脂抗体、抗疟药和外源性雌激素的使用在中国患者中较少见。在考克斯回归模型中，低水平高密度脂蛋白胆固醇、中国种族、口腔溃疡和浆膜炎预测动脉事件，而男性、低水平高密度脂蛋白胆固醇、抗磷脂抗体、非中国种族、肥胖、肾脏疾病和溶血性贫血预测静脉事件。SLE患者的动脉和静脉血栓栓塞的发生率存在种族差异，这不能完全用所研究的临床因素来解释。其他遗传和免疫因素的进一步评估是必要的。
Objective. To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds.Methods. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins.Results. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean +/- SD age at SLE diagnosis was 35.7 +/- 14 years. After a followup of 3,094 patient-years, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P = 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events.Conclusion. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.