Vasculitis in systemic lupus erythematosus -: Prevalence and clinical characteristics in 670 patients
Vasculitis in systemic lupus erythematosus -: Prevalence and clinical characteristics in 670 patients
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DOI：
10.1097/01.md.0000216817.35937.70
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发表时间：
2006-03-01
期刊：
影响因子：
1.6
通讯作者：
Font, J
中科院分区：
文献类型：
--
作者：
Ramos-Casals, M;Nardi, N;Font, J
我们进行了目前的研究，以确定血管炎的患病率和临床特点，在一个大系列的系统性红斑狼疮（SLE）患者，侧重于不同类型的血管炎的分类和临床意义。我们研究了670例符合1997年修订的SLE标准中4项或4项以上的连续患者。组织学和/或动脉造影诊断为明确的血管炎，当有特征性皮肤病变时，临床诊断为可能的血管炎。根据查佩尔山共识会议采用的定义对血管炎进行分类。76例（11%）SLE患者有血管炎（68例女性患者和8例男性患者;平均年龄37.8岁）;只有32例（42%）符合查佩尔山的定义。皮肤病变是血管炎的主要临床表现，存在于68例（89%）患者中，而其余8例（11%）为孤立性内脏血管炎。与无血管炎的SLE患者相比，血管炎患者的网状青斑患病率更高（22% vs. 3%; p = 0.028）;平均欧洲共识狼疮活动性测量（ECLAM）评分较高（5.86 vs. 3.87; p < 0.001）;贫血的频率较高在多变量分析中，红细胞沉降率（ESR）> 50 mm/h（60% vs. 15%，p < 0.001）和抗La/SS-B抗体（19% vs. 5%; p = 0.014）。关于受累血管的大小，65例（86%）患者患有小血管炎（SVV），11例（14%）患者患有中等血管炎（MVV）。SLE合并MVV患者多发性单神经炎患病率较高（54% vs. 2%; p < 0.001），内脏血管炎（100% vs. 5%; p < 0.001）和溃疡/缺血性皮肤病变（36% vs. 11%; p = 0.047）和更高比例的手术干预（45%对0%; p < 0.001）。总之，我们观察到SLE患者血管炎的异质性表现，近60%的病例不符合查佩尔山共识会议通过的名称和定义。SVV是最常见的血管炎，绝大多数是皮肤性的，与MVV有明显的区别，MVV不太常见，但主要累及内脏（特别是周围神经）。SLE患者血管炎的存在与较高的ECLAM评分、网状青斑、血液学参数（贫血、高ESR）和抗La/SS-B抗体相关。
We conducted the current study to determine the prevalence and clinical characteristics of vasculitis in a large series of patients with systemic lupus erythematosus (SLE), focusing on the classification and clinical significance of the different types of vasculitis. We studied 670 consecutive patients who fulfilled 4 or more of the 1997 revised criteria for SLE. Definite vasculitis was diagnosed histologically and/or by arteriography, and probable vasculitis was diagnosed clinically when there were characteristic cutaneous lesions. Vasculitides were categorized according to the definitions adopted by the Chapel Hill Consensus Conference. Seventy-six (11%) patients with SLE had vasculitis (68 female patients and 8 male; mean age, 37.8 yr); only 32 (42%) fulfilled the Chapel Hill definitions. Cutaneous lesions were the main clinical presentation of vasculitis, present in 68 (89%) patients, while the remaining 8 (11%) had isolated visceral vasculitis. Compared with SLE patients without vasculitis, patients with vasculitis had a higher prevalence of livedo reticularis (22% vs. 3%; p = 0.028); a higher mean European Consensus Lupus Activity Measurement (ECLAM) score (5.86 vs. 3.87; p < 0.001); and a higher frequency of anemia (62% vs. 17%; p < 0.001), erythrocyte sedimentation rate (ESR) > 50 mm/h (60% vs. 15%, p < 0.001), and anti-La/SS-B antibodies (19% vs. 5%; p = 0.014) in the multivariate analysis. With respect to the size of the vessels involved, 65 (86%) patients had small vessel vasculitis (SVV) and 11 (14%) had medium-sized vessel vasculitis (MVV). SLE patients with MVV had a higher prevalence of mononeuritis multiplex (54% vs. 2%; p < 0.001), visceral vasculitis (100% vs. 5%; p < 0.001), and ulcerated/ischemic cutaneous lesions (36% vs. 11%; p = 0.047) and a higher percentage of surgical interventions (45% vs. 0%; p < 0.001) compared with patients with SVV.In conclusion, we observed a heterogeneous presentation of vasculitides arising in the setting of SLE, with nearly 60% of cases not fulfilling the names and definitions adopted by the Chapel Hill Consensus Conference. SVV was the most frequent vasculitis, overwhelmingly cutaneous and clearly differentiated from MVV, which was less frequent but had predominantly visceral involvement (especially of the peripheral nerves). The presence of vasculitis in Our patients with SLE was associated with a higher ECLAM score, livedo reticularis, hematologic parameters (anemia, high ESR), and anti-La/SS-B antibodies.