系统性红斑狼疮亚临床动脉粥样硬化及相关因素的研究  

Frequency of subclinical atherosclerosis and associated factors in patients with systemic lupus erythematosus

作　　者：黄艳荣 季兰岚[1] 高岱 高澜[3] 杨颖[3] 郝燕捷[1] 张卓莉[1] Huang Yanrong;Ji Lanlan;Gao Dai;Gao Lan;Yang Ying;Hao Yanjie;Zhang Zhuoli(Department of Rheumatology and Immunology,Peking University First Hospital,Beijing 100034,China;Department of Rheumatology and Immunology,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;Department of Cardiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,100034 [2]广西医科大学第二附属医院风湿免疫科,南宁530007 [3]北京大学第一医院心内科,100034

出　　处：《中华风湿病学杂志》2020年第12期820-825,共6页Chinese Journal of Rheumatology

摘　　要：目的探讨SLE患者亚临床动脉粥样硬化的发生率及相关因素。方法入选SLE随访队列中90例既往无临床动脉粥样硬化疾病的患者。记录人口学特征、动脉粥样硬化危险因素、SLE相关指标、SLEDAI、医生对病情的整体评估(PGA)及脏器损伤指数(SDI)。根据超声双侧颈动脉内中膜厚度(IMT)以及颈动脉有无动脉斑块形成,将患者分为合并或不合并亚临床动脉粥样硬化组。采用Mann-Whitney U检验、χ^2检验及Logistic回归分析进行统计。结果90例SLE患者的IMT均值为[(0.53±0.19)mm]。18例(20%)患者内中膜增厚或者有颈动脉斑块形成,判定为合并亚临床动脉粥样硬化。单因素分析显示,在传统危险因素方面,与无亚临床动脉粥样硬化的患者相比,合并亚临床动脉粥样硬化的SLE患者年龄更高[(36±13)岁与(49±17)岁,Z=3.033,P=0.002],收缩压更高[(123±14)mmHg与(138±27)mmHg;Z=2.407,P=0.016]及Framingham评分更高[3(-4,9)与10(5,16);Z=3.167,P=0.002];在SLE相关危险因素方面,SLEDAI[4(2,6)与8(2,15);Z=2.939,P=0.003],PGA[1(0,2)与2(1,3);Z=2.723,P=0.006]、肾小球滤过率(eGFR)[(85±17)ml/min与(67±20)ml/min;Z=-3.307,P=0.001]在2组间差异均有统计学意义。多因素Logistic回归分析结果显示,Framingham评分[OR=1.157,95%CI(1.042,1.286);P=0.007]和SLEDAI[OR=1.184,95%CI(1.030,1.361);P=0.017]是SLE合并亚临床动脉粥样硬化的独立风险因素。结论SLE疾病活动度也是亚临床动脉粥样硬化发生的独立危险因素。在SLE长期治疗中要重视动脉粥样硬化风险,早期干预,进一步改善患者的预后。Objective To evaluate subclinical atherosclerosis and associated factors in patients with systemic lupus erythematosus(SLE).Methods Ninety SLE patients without clinical cardiovascular disease history were recruited.Demographic atherosclerotic risk factors,SLE-related clinical and laboratory indicators,SLE disease activity index(SLEDAI),physician global assessment(PGA),and Systemic Lupus International Collaborating Clinics(SLICC)Damage Index(SDI)were recorded.Duplex carotid sonography was performed in all patients to assess the intima-media thickness(IMT)and carotid plaque formation.Mann-Whitney U test,Chi-square test,and Logistic regression analysis were used for statistical analyses.Results The mean IMT of 90 patients was[(0.53±0.19)mm].Subclinical atherosclerosis was confirmed in 18(20%)patients,with presence of either thickened intima-media or carotid plaque formation.Comparing with patients without subclinical atherosclerosis,patients with subclinical atherosclerosis were older[(36±13)years vs(49±17)years;Z=3.033,P=0.002],with higher systolic blood pressure[(123±14)mmHg vs(138±27)mmHg;Z=2.407,(P=0.016)],and higher Framingham risk score[3(-4,9)vs 10(5,16);Z=3.167,(P=0.002)].Significantly higher SLEDAI[4(2,6)vs 8(2,15);Z=2.939,(P=0.003)]、PGA[1(0,2)vs 2(1,3);Z=2.723,(P=0.006)],and lower estimated glomerular filtration rate[(85±17)ml/min vs(67±20)ml/min;Z=-3.307,(P=0.001)]were also observed in those patients with subclinical atherosclerosis.Multiple logistic regression analysis showed that Framingham risk score[OR=1.157,95%CI(1.042,1.286);P=0.007]and SLEDAI[OR=1.184,95%CI(1.030,1.361);P=0.017]were the independent factors for the presence of subclinical atherosclerosis in SLE patients.Conclusion In addition to traditional cardiovascular risk factors,disease activity is also an risk factor for subclinical atherosclerosis in SLE patients.Being aware of the atherosclerotic complications independent and early intervention of risk factors are important to improve the long-term prognosis of SLE patients.

关 键 词：红斑狼疮 系统性 动脉粥样硬化 疾病活动度 

分 类 号：R593.241[医药卫生—内科学] R543.5[医药卫生—临床医学]