OUTCOME OF SLE IN MINORITIES--NATURE VS NURTURE

越来越多的数据表明，遗传因素，特别是基因 主要组织相容性复合体，对课程的影响和 风湿病的预后。同样，最近的研究也证明了 社会经济因素在这些疾病结果中的重要性。 系统性红斑狼疮(SLE)是一种变异很大的疾病 其患病率、发病率和死亡率已被发现更高 在少数群体中。这项建议旨在探讨影响 通过检查SLE少数民族人群中较高的发病率 社会经济、人口、文化、免疫遗传和 一项早期队列研究中的临床变量对早期结果的影响 2名西班牙裔、非裔美国人和高加索人SLE患者 地理区域(德克萨斯州休斯顿和亚利桑那州伯明翰)。因为大多数基因 关于系统性红斑狼疮的研究主要集中在欧洲血统的高加索人身上 都受到了这个相对 同种种族群体。因此，人类白细胞抗原II类基因分型(HLADRB1， DRB3、DRB5、DQA1、DQB1和DPB1等位基因)将由 寡核苷酸分型及其基因剂量和III型C4和C2 将确定80名拉美裔和80名非洲人的蛋白质同种异型。 美国人和80名高加索人先后参加了这项研究。这个 不同种族和民族的系统性红斑狼疮检查不仅 使我们有机会更好地确定特定基因的作用 在SLE的发病机制中，却提供了独特的机会来检查 其他与种族不同的因素--例如医疗保健 行为、遵从性、教育和共病--以确定 遗传和社会文化因素在系统性红斑狼疮预后中的相互作用 无论是少数群体还是非少数群体。5年或以下的患者 疾病持续时间将从现有的狼疮登记处招募，地址为 阿拉巴马大学伯明翰分校(UAB)和德克萨斯大学 休斯顿健康科学中心(UTHSC)，正在扩大到 确保完整的案件查明。西班牙裔患者将被招募 在UTHSC(和加尔维斯顿的UT医学部)，而非裔美国人 高加索患者将在UAB和UTHSC招募。结果 这些措施将每两年评估一次，为期三年。结果是 被检查对早期变化敏感，包括频率和 耀斑严重程度、疾病活动性(SLAM)和严重程度(SLICC)，以及 功能障碍除了更传统的参数外，如 肾脏存活率和存活率本身。这将是第一个系统化的 美国首次对西班牙裔系统性红斑狼疮患者进行研究 不同种族中遗传和社会文化因素之间的相互作用 以及患有系统性红斑狼疮的民族。

A growing body of data suggests that genetic factors, particularly genes of the major histocompatibility complex, impact on the course and prognosis of rheumatic diseases. Likewise, recent work attests to the importance of socioeconomic factors in the outcome of these disorders. Systemic Lupus Erythematosus (SLE) is a disease of great variability whose prevalence, morbidity, and mortality have been found to be higher in minority groups. This proposal seeks to explore the factors underlying higher morbidity in minority groups with SLE by examining the relationship of socioeconomic, demographic, cultural, immunogenetic, and clinical variables to early outcome in an inception cohort study of Hispanic, African-American, and Caucasian SLE patients from 2 geographical areas (Houston, TX and Birmingham, AL). Since most genetic studies on SLE have focused on Caucasians of European ancestry, findings have been limited by linkage disequilibrium within this relatively homogeneous racial group. Therefore, HLA class II genotypes (HLA-DRB1, DRB3, DRB5, DQA1, DQB1 and DPB1 alleles) will be determined by oligotyping as well as gene dosage thereof, and class III C4 and C2 protein allotypes will be determined in each of 80 Hispanics, 80 African- American and 80 Caucasians consecutively enrolled into the study. The examination of SLE across different racial and ethnic groups not only allows us the opportunity to better determine the role of specific genes in the pathogenesis of SLE, but allows the unique opportunity to examine other factors differentially related to ethnicity - such as health care behavior, compliance, education, and comorbidities - to determine the interplay of genetic and socio-cultural factors in the outcome of SLE in both minority and non-minority groups. Patients with 5 years or less of disease duration will be recruited from the existing lupus registries at the University of Alabama at Birmingham (UAB) and the University of Texas Health Sciences Center (UTHSC) at Houston which are being expanded to insure complete case ascertainment. Hispanic patients will be recruited at UTHSC (and UT Medical Branch at Galveston) whereas African-American and Caucasian patients will be recruited at both UAB, and UTHSC. Outcome measures will be evaluated biannually for three years. The outcomes to be examined are sensitive to early change and include frequency and severity of flares, disease activity (SLAM) and severity (SLICC), and functional disability in addition to more traditional parameters such as renal survival and survival per se. This will be the first systematic study of Hispanics with SLE in the United States and the first to examine the interplay among genetic and socio-cultural factors in diverse racial and ethnic groups with SLE.