系统性红斑狼疮亚临床动脉粥样硬化危险因素研究

The analysis of risk factors for sub-clinical atherosclerosis in systemic lupus erythematosus

目的评价系统性红斑狼疮（SLE）患者亚临床动脉粥样硬化的发生率、传统及非传统危险因素对动脉粥样硬化发生的影响。方法选择58例确诊SLE同时既往无动脉粥样硬化疾病发生的患者作为研究对象。记录其传统危险因素、SLE临床及实验室指标、活动度评分、治疗情况，同时通过颈动脉彩色多普勒超声测量双侧颈动脉内中膜厚度（IMT）并观察有无动脉粥样硬化斑块。结果58例患者中IMT增厚者22例（38％），有动脉粥样硬化斑块者10例（17％）。有斑块者较无斑块者SLE病程更长，同时存在更多传统危险因素：年龄大、有高血压、糖尿病及已绝经者多，有更高的收缩压、总胆固醇及低密度脂蛋白水平。多因素分析显示，患者所具有的传统危险因素的数量及SLE病程是出现颈动脉粥样硬化斑块的独立危险因素。结论传统危险因素在SLE患者动脉粥样硬化的发生中仍然发挥着重要作用，应该积极地予以控制。SLE病程是影响动脉粥样硬化发生的非传统独立危险因素，随着病程的延长，应该定期进行相关检查，尽早发现并治疗。

Objective To evaluate the traditional and non-traditional risk factors for sub-clinical atherosclerosis in systemic lupus erythematosus （SLE）. Methods A cross-sectional cohort of 58 lupus patients without overt atherosclerotic disease were included, and the traditional risk factors for atherosclemsis, lupus disease activity and treatments were evaluated. Meanwhile, duplex carotid sonography was used to measure intima-media thickness （IMT） and assess plaques of the carotid arteries. Results The Average age of 58 patients was （39.0±11.7） years with an average disease duration of（8.4±6.3 ） years. Thickened IMT and plaque were detected in 22/58 （37.9%） and in 10/58 （17.2%） of patients respectively. Compared to those without plaque, the patients with carotid plaque were older, and more in postmenopausal. Hypertension and diabetes presented more frequently and higher total serum cholesterol and low density lipoprotein in patients with plaque. These patients also had more traditional risk factors （2.8±1.0 vs 0.9±1.0, P〈0.01 ） with longer SLE duration [（15.1±6.7） years vs （7.0±5.3） years, P〈0.01]. Multivariate analysis showed that more traditional risk factors （Odd ratio, 5.39） and longer SLE duration （Odd ratio, 1.20） were independent pred- ictors of plaque. Conclusion The role of traditional risk factors for atherosclerosis is confirmed in lupus patients. The duration of SLE as a non-traditional risk factor for atherosclerosis is also a possiblerisk factor based on the result of this study. Early control of traditional risk factors and early interventions should be recommended.