Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus -: results from LUMINA (LIX):: a multiethnic US cohort
Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus -: results from LUMINA (LIX):: a multiethnic US cohort
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DOI：
10.1093/rheumatology/ken208
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发表时间：
2008-07-01
期刊：
影响因子：
5.5
通讯作者：
Alarcon, G. S.
中科院分区：
文献类型：
--
作者：
Duran-Barragan, S.;McGwin, G., Jr.;Alarcon, G. S.
Objective.检测血管紧张素转换酶（ACE）抑制剂的使用是否能延迟SLE患者肾脏受累的发生并降低疾病活动的风险。研究了来自少数民族狼疮：先天与后天（LUMINA）队列的SLE患者（西班牙裔，非洲裔美国人和高加索人）。肾脏受累定义为ACR标准和/或活检证实的狼疮性肾炎。通过单变量和多变量考克斯比例风险回归分析检查肾脏受累的时间。采用病例交叉设计和条件Logistic回归模型对疾病活动性进行了检查;在病例间隔期内，SLAM-R评分下降>= 4分，但在对照间隔期内没有。378例患者中有80例（21%）为ACE抑制剂使用者; 298例（79%）未使用。使用者10年无肾受累生存率为88.1%，非使用者为75.4%（P = 0.0099，对数秩检验）。使用者发生持续性蛋白尿和/或活检证实的狼疮性肾炎（7.1%）的频率低于非使用者（22.9%），P = 0.016。通过多变量考克斯比例风险回归分析，ACE抑制剂的使用[风险比（HR）0.27; 95% CI 0.09，0.78]与较长的肾脏受累发生时间相关，而非洲裔美国人（HR 3.31; 95% CI 1.44，7.61）的时间较短。ACE抑制剂的使用（54/288例病例和254/1148对照间期）也与疾病活动风险降低相关（HR 0.56; 95%CI 0.34，0.94）。ACE抑制剂的使用可延迟肾脏受累的发展，并与SLE疾病活动风险降低相关;在制定实践建议之前，需要在其他狼疮队列中证实这些发现。
Objective. To examine if angiotensin-converting enzyme (ACE) inhibitor use delays the occurrence of renal involvement and decreases the risk of disease activity in SLE patients.Methods. SLE patients (Hispanics, African Americans and Caucasians) from the lupus in minorities: nature vs nurture (LUMINA) cohort were studied. Renal involvement was defined as ACR criterion and/or biopsy-proven lupus nephritis. Time-to-renal involvement was examined by univariable and multivariable Cox proportional hazards regression analyses. Disease activity was examined with a case-crossover design and a conditional logistic regression model; in the case intervals, a decrease in the SLAM-R score >= 4 points occurred but not in the control intervals.Results. Eighty of 378 patients (21%) were ACE inhibitor users; 298 (79%) were not. The probability of renal involvement free-survival at 10 yrs was 88.1% for users and 75.4% for non-users (P = 0.0099, log rank test). Users developed persistent proteinuria and/or biopsy-proven lupus nephritis (7.1%) less frequently than non-users (22.9%), P = 0.016. By multivariable Cox proportional hazards regression analyses, ACE inhibitors use [hazard ratio (HR) 0.27; 95% CI 0.09, 0.78] was associated with a longer time-to-renal involvement occurrence whereas African American ethnicity (HR 3.31; 95% CI 1.44, 7.61) was with a shorter time. ACE inhibitor use (54/288 case and 254/1148 control intervals) was also associated with a decreased risk of disease activity (HR 0.56; 95% CI 0.34, 0.94).Conclusions. ACE inhibitor use delays the development of renal involvement and associates with a decreased risk of disease activity in SLE; corroboration of these findings in other lupus cohorts is desirable before practice recommendations are formulated.