系统性红斑狼疮患者氧化低密度脂蛋白水平与颈动脉硬化关系分析  

Relationship between oxidized low density lipoprotein and carotid atherosclerosis in patients with systemic lupus erythematosus

作　　者：李敏 郭毅飞 龚丽 李雪锋 LI Min;GUO Yifei;GONG Li;LI Xuefeng(Department of Endocrinology and Rheumatology,Shiyan City Taihe Hospital,Shiyan 442000,China)

机构地区：[1]湖北省十堰市太和医院/湖北医药学院附属医院内分泌风湿病科,442000

出　　处：《疑难病杂志》2018年第11期1256-1260,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金面上项目(81372998)

摘　　要：目的分析系统性红斑狼疮(SLE)患者血浆中氧化低密度脂蛋白(ox-LDL)水平的变化及其与颈动脉粥样硬化的关系。方法收集2015年5月—2016年11月十堰市太和医院内分泌风湿病科收治的SLE患者78例,采用彩色多普勒超声对患者进行颈总动脉内膜中层厚度(IMT)测定,分为斑块组(40例)和无斑块组(38例),以同期健康体检者72例作为健康对照组。检测所有研究对象ox-LDL、胰岛素抵抗指数(HOMA-IR)、血脂、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、补体C3及C4、抗双链DNA抗体(ds-DNA)水平,并计算SLE疾病活动度指数(SLEDAI)。采用Pearson相关分析和Logisitic回归分析各指标的相关性和独立危险因素。结果斑块组颈动脉IMT及血清ox-LDL水平显著高于无斑块组和健康对照组(F=122. 4、131. 4,P=0. 004、0. 003)。SLE患者ox-LDL水平分别与HOMA-IR、ESR、hs-CRP、ds-DNA、IMT及SLEDAI呈正相关性(r/P=0. 534/0. 001、0. 335/0. 012、0. 376/0. 002、0. 472/0. 001、0. 324/0. 015)。Logistic回归分析显示,ox-LDL(OR=1. 121,95%CI 1. 032～1. 232)、TG(OR=2. 343,95%CI 1. 056～4. 321)和HOMA-IR(OR=1. 991,95%CI 1. 342～4. 556)是影响颈动脉粥样硬化的独立相关因素。结论SLE患者ox-LDL水平显著增加,且与疾病活动度密切相关。Objective To analyze the changes of plasma oxidized low density lipoprotein(ox-LDL)and its relationship with carotid atherosclerosis in patients with systemic lupus erythematosus(SLE).Methods Seventy-eight SLE patients admitted to the Department of Endocrinological Rheumatology in Shiyan Taihe Hospital from May 2015 to November 2016 were divided into plaque group(40 cases)and plaque-free group(38 cases)by color Doppler ultrasonography.72 healthy subjects were selected as healthy control group at the same time.The levels of ox-LDL,insulin resistance index(HOMA-IR),serum lipid,erythrocyte sedimentation rate(ESR),high-sensitivity C-reactive protein(hs-CRP),complement C3 and C4,and anti-ds-DNA antibody(ds-DNA)were measured in all subjects,and the disease activity index(SLEDAI)was calculated.Pearson correlation analysis and Logisitic regression analysis were used to analyze the correlation and independent risk factors of each index.Resluts The levels of IMT and ox-LDL in carotid artery of plaque group were significantly higher than those of non-plaque group and healthy control group(F=122.4,F=131.4,P=0.004,P=0.003).The levels of ox-LDL in SLE patients were positively correlated with HOMA-IR,ESR,hs-CRP,ds-DNA,IMT and SLEDAI respectively(r/P=0.534/0.001,r/P=0.335/0.012,r/P=0.376/0.002,r/P=0.472/0.001,r/P=0.324/0.015).Logistic regression analysis showed that ox-LDL(OR=1.121,95%CI 1.032-1.232),TG(OR=2.343,95%CI 1.056-4.321)and HOMA-IR(OR=1.991,95%CI 1.342-4.556)were independent risk factors for carotid atherosclerosis.Conclusion There is a significant increase of ox-LDL in SLE patients,which is closely related to disease activity.The increase of ox-LDL may play a role in the pathogenesis of atherosclerosis.

关 键 词：系统性红斑狼疮 氧化低密度脂蛋白 颈动脉硬化 

分 类 号：R593.241[医药卫生—内科学] R543.4[医药卫生—临床医学]