高血压与高同型半胱氨酸血症的交互作用对系统性红斑狼疮患者颈动脉粥样硬化的影响  

Effect of interaction between hypertension and hyperhomocysteinemia on carotid atherosclerosis in patients with systemic lupus erythematosus

作　　者：王彩梅[1] 于健[2] 彭鹏 石祥 何永玲[1] 毛国飞 邓金环 姚爽 Wang Caimei;Yu Jian;Peng Peng;Shi Xiang;He Yongling;Mao Guofei;Deng Jinhuan;Yao Shuang(Department of Laboratory,Affiliated Hospital of Guilin Medical College,Guilin 541001,Guangxi Zhuang Autonomous Region,China;Department of Endocrine,Affiliated Hospital of Guilin Medical College,Guilin 541001,Guangxi Zhuang Autonomous Region,China;Guilin Medical College,Guilin 541199,Guangxi Zhuang Autonomous Region,China;Department of Rheumatism and Immunity,the Second Affiliated Hospital of Guilin Medical College,Guilin 541000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]桂林医学院附属医院检验科,广西壮族自治区桂林541001 [2]桂林医学院附属医院内分泌科,广西壮族自治区桂林541001 [3]桂林医学院,广西壮族自治区桂林541199 [4]桂林医学院第二附属医院风湿免疫科,广西壮族自治区桂林541100

出　　处：《中国中西医结合急救杂志》2023年第2期204-207,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广西壮族自治区卫生健康委员会科研课题(Z20190303);广西壮族自治区高校中青年教师科研基础能力提升项目(2021KY0494)。

摘　　要：目的高血压与高同型半胱氨酸血症的交互作用对系统性红斑狼疮(SLE)患者颈动脉粥样硬化的影响.方法选择2019年2月至2020年10月在桂林医学院附属医院住院的209例SLE患者作为研究对象.收集患者的临床资料,包括人口学特征、SLE病程、体质量指数(BMI)、同型半胱氨酸(Hcy)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、纤维蛋白原(Fib)、尿酸、补体C3和C4、SLE疾病活动度指数(SLEDAI)评分、血清抗双链DNA(抗dsDNA)抗体、抗Sm抗体、抗干燥综合征B(抗SSB)抗体、抗核糖体P蛋白(抗RNP)抗体和肾脏损害、高血压、糖尿病、血脂异常患者的比例等资料.根据颈动脉彩色B超检查结果将患者分为SLE颈动脉粥样硬化组(31例)和对照组(178例),比较两组上述指标的差异.采用Pearson相关性分析法分析性别、年龄、SLE病程、BMI、Hcy、ESR、CRP、Fib、尿酸、补体C3和C4、SLEDAI评分、抗dsDNA抗体、抗Sm抗体、抗SSB抗体、抗RNP抗体及肾脏损害、高血压、糖尿病、血脂异常与SLE患者颈动脉粥样硬化的相关性.采用Logistic回归模型分析影响SLE患者颈动脉粥样硬化的独立危险因素,应用相加模型及相乘模型对危险因素间的交互作用进行定量分析.结果SLE颈动脉粥样硬化组患者年龄、Hcy、ESR、SLEDAI评分及高血压、糖尿病、血脂异常的患者比例均明显高于对照组[年龄(岁):48(27~66)比37(18~84),Hcy(μmol/L):15.20(4.20~25.00)比9.80(3.60~22.70),ESR(mm/1 h):55(3~133)比28(2~120),SLEDAI评分(分):6(2~16)比4(0~22),高血压患者比例:45.2%(14/31)比10.7%(19/178),糖尿病患者比例:19.4%(6/31)比4.5%(8/178),血脂异常患者比例:35.5%(11/31)比14.0%(25/178),均P<0.05].单因素Logistic回归分析显示:高血压及高Hcy血症同时存在时SLE患者颈动脉粥样硬化的患病风险为无高血压及Hcy正常者的39.704倍[优势比(OR)=39.704,95%可信区间(95%CI)为8.960~175.937],协同效应指数为4.64,相对超额危险度(RERI)为30Objective To investigate the effect of the interaction between hypertension and hyperhomocysteinemia on carotid atherosclerosis in systemic lupus erythematosus(SLE).Methods A total of 209 SLE patients hospitalized admitted to Affiliated Hospital of Guilin Medical College from February 2019 to October 2020 were selected as the research subjects.Collect clinical data of patients,including demography characteristics,SLE course of disease,body mass index(BMI),homocysteine(Hcy),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),fibrinogen(Fib),uric acid(UA),complement C3 and C4,SLE disease activity index(SLEDAI)score,serum anti-double-stranded DNA(anti-dsDNA)antibody,anti-Sm antibody,anti-SjOgren syndrome B(anti-SSB)antibody,anti-ribosomal P protein(anti-RNP)antibodies,and the proportion of patients with kidney damage,hypertension,diabetes,and dyslipidemia.According to the results of carotid artery color B ultrasound examination,they were divided into carotid atherosclerosis group(n=31)and control group(n=178),and the differences of the above indexes between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between sex,age,SLE course of disease,BMI,Hcy,ESR,CRP,Fib,UA,complement C3 and C4,SLEDAI score,anti-dsDNA antibody,anti-Sm antibody,anti-SSB antibody,anti-RNP antibody,kidney damage hypertension,diabetes,dyslipidemia,and carotid atherosclerosis in SLE patients.The independent effects of risk factors were studied by Logistic regression model,and the interaction between risk factors was analyzed by additive model and multiplicative model.Results The age,Hcy,ESR,SLEDAI score,prevalence of hypertension,diabetes,and dyslipidemia in the carotid atherosclerosis group were significantly higher than those in the control group[age(years):48(27-66)vs.37(18-84),Hcy(μmol/L):15.20(4.20-25.00)vs.9.80(3.60-22.70),ESR(mm/1 h):55(3-133)vs.28(2-120),SLEDAI score 6(2-16)vs.4(0-22),prevalence of hypertension:45.2%(14/31)vs.10.7%(19/178),prevalence of diabetes:19.4%(6/31)vs.4.5%(8/17

关 键 词：系统性红斑狼疮 颈动脉粥样硬化 高血压 高同型半胱氨酸血症 交互作用 

分 类 号：R593.241[医药卫生—内科学]