系统性红斑狼疮患者血脂异常危险因素分析

Risk factors of dyslipidemia in patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)患者血脂特点及其危险因素。方法收集540例SLE患者的临床资料和血脂化验结果,分析SLE患者临床特征、实验室指标、治疗药物与总胆固醇(TC)升高的关系。结果 487例(90.2%)SLE患者血脂异常,TC升高、甘油三酯(TG)升高、高密度脂蛋白胆固醇(HDL-C)减低、低密度脂蛋白胆固醇(LDL-C)升高例数(比例)分别为297例(55.0%)、366例(67.8%)、228例(42.2%)、249例(46.1%)。Logistic回归分析显示狼疮肾炎、大量蛋白尿、激素治疗及血脂测定前30 d激素总量>1 g(等量换算为口服泼尼松剂量)是TC升高的独立危险因素(P<0.05),hsCRP升高和自身免疫性血小板减少(ITP)与TC升高呈负相关(P<0.05)。TC升高与病程、低补体、激素治疗时间、血脂测定前激素日剂量及免疫抑制剂的使用无明显相关性(P>0.05)。结论 SLE患者存在着明显的脂代谢紊乱,TC升高与肾损害和激素作用密切相关。

Objective To study the characteristics and risk factors of dyslipidemia in patients with systemic lupus erythematosus. Methods Clinical data and serum lipid levels were collected to analysis the relationship between the clinical features, glucocorticoid therapy treatment drug and elevated total cholesterol. Results Dyslipidemia were found in 487 patients（90.2%）, elevated TC was found in 297 patients（55.0%）, elevated triglyceride in 366 patients（67.8%）, low high density lipoprotein cholesterol in 228 patients（42.2%） and elevated low density lipoprotein cholesterol in 249 patients（46.1%）. Logistic regression analysis showed that lupus nephritis, severe proteinuria, glucocorticoid treatment, cumulative glucocorticoid dose of 30 days before serum lipids assay〉1.0 g（equivalent conversion to oral prednisone dose） were independent risk factors of elevated TC in SLE patients（P〈0.05）, there were negative association between positive hsCRP, autoimmune thrombocytopenia and elevated TC（P〈0.05）. There were no association between disease duration, low complement, glucocorticoid treatment time, glucocorticoid daily dose, the use of immunosuppressant and elevated TC（P〉0.05）. Conclusion SLE patients have severe dyslipidemia, elevated TC are associated with renal damage and glucocorticoid treatment.