系统性红斑狼疮中疾病相关危险因素与早发动脉粥样硬化的关系

The relationship between disease-related risk factors and premature atherosclerosis in systemic lupus erythematosus

目的研究绝经期前系统性红斑狼疮（SLE）女性患者动脉粥样硬化的发病情况，探讨SLE疾病相关因素等非传统危险因素在SLE早发动脉粥样硬化中的作用。方法对111例绝经前SLE女性患者及40名健康女性进行研究。人选对象均要求无临床心血管疾病史。采用颈动脉超声检测颈部动脉粥样硬化斑块，同时测定颈动脉内膜中层厚度（1MT）。对SLE疾病相关因素与动脉粥样硬化之间的关系进行研究。采用肱动脉超声检测血管内皮功能，以此评价SLE患者与健康对照之间内皮功能的差异。采用t检验、x^2检验和Logistic回归分析等方法进行统计学分析。结果在110例绝经前SLE患者中有16例（14．4％）存在颈动脉斑块，而在40名健康对照组中无一例存在颈动脉斑块（P=0．007）。SLE患者组的平均IMT（in—IMT）（0．62mm）高于健康对照组（0．45mm）（P〈0．01），最大IMT（M—IMT）（0．7mm）高于健康对照组（0．6mm）（P〈0．01）。SLE患者中有颈动脉斑块者相对于无斑块者年龄更大，病程更长，体质量指数（BMI）更大，血压偏高，凝血酶原时问更短，C反应蛋白更高，系统性红斑狼疮损伤指数（SLICC）积分更高，累积激素剂量更大，更少使用羟基氯喹，m—IMT和M—IMT更大，血流介导的血管扩张功能（FMD）和硝酸甘油介导的血管扩张功能（NMD）减弱（P均〈0．05）。运用Logistic回归分析，在SLE患者中，年龄增大（P=0．012，OR=1．137），BMI增高（P=0．051，OR=1．205），SLICC积分增高（P=0．000，OR=2．888）是发生颈动脉斑块的独立预测指标。结论SLE患者颈动脉粥样硬化斑块的发生率明显高于健康对照。除了传统心血管疾病危险因素的影响外，SLE本身以及与疾病相关的一些因素也参与其中，对SLE早发动脉粥样硬化起重要作用。SLE患者有明显的血管内皮功能障碍，因此，内皮功能受损也可看作SLE早发动脉粥样硬化的一个表现。

Objective To evaluate the prevalence of atherosclerosis in Chinese premenopausal women with systemic lupus erythematosus （SLE） and study possible associations between non-traditional risk factors with premature atherosclerosis. Methods One hundred and eleven premeuopausal women with SLE and 40 healthy controls without clinical cardiovascular disease were evaluated. B-mode ultrasonography was used to measure carotid plaque and intima-media wall thickness（IMT）. The relationship between the patients＇ clinical characteristics and carotid plaque was examined. At the same time, B-mode ultrasound was used to measure flow-mediated dilation （FMD） and nitroglycerin-mediated dilation （NMD） in the brachial artery. Using this method, the difference in endothelial function between SLE patients and controls was assessed. T-test, x^2 test and logistic regression were used for statistical analysis. Results Carotid plaque was more frequently observed in patients with SLE （16 of 111 patients） than in control subjects （0 of 40 subjects） （P=0.007）. The mean IMT （m-IMT） （0.62 mm vs 0.45 ram, P〈0.01 ） and maximum IMT（M-IMT） （0.7 mm vs 0.6 ram, P〈0.01） was significantly higher in patients than in controls. As compared with patients without plaque, patients with plaque were significantly older, had longer disease duration, higher body mass index （BMI）, higher blood pressure, shorter prothrombin time, elevated C-reactive protein level, higher SLICC score, higher cumulative prednisone dose, less hydroxychloroquine accumulated dosage, higher m-IMT and M-IMT, lower FMD and NMD. In logistic regression analysis, older age （P=0.012, OR=1.137）, higher BMI （P=0.051, OR=1.205） and higher SLICC score （P=0.000, OR=2.888 ） were independently related to the presence of plaque. Conclusion SLE patients have higher prevalence of carotid atheroselerosis plaque than healthy controls and the age at onset is younger than controls. In addition to traditional risk factors for cardiovascular disease, SLE itself and disease related factors play important roles in premature atherosclerosis in SLE. SLE patients have significant endothelial dysfunction. Thus, endothelial dysfunction can be regarded as one manifestation of premature atherosclerosis in SLE.