系统性红斑狼疮患者动脉僵硬度及其相关危险因素的研究

Incidence and associated risk factors of arterial stiffness in patients with systemic lupus erythematosus

目的 评价系统性红斑狼疮（SLE）患者动脉僵硬度,并探讨其相关危险因素.方法 本研究为横断面研究,共纳入中国系统性红斑狼疮研究协作组（CSTAR）的SLE患者135例.利用动脉僵硬度检测仪测定患者臂踝脉搏波传导速度（baPWV）,同时采集心血管相关的传统危险因素以及SLE相关因素.利用SAS软件进行统计分析.结果 （1）动脉僵硬度增高的SLE患者其年龄、心血管疾病家族史、平均动脉压和糖化血红蛋白与动脉僵硬度正常的SLE患者比较差异有统计学意义（P均＜0.05）.动脉僵硬度增高的SLE患者其肌酐清除率低于动脉僵硬度正常的SLE患者,病程和羟氯喹使用疗程长于动脉僵硬度正常的SLE患者（P均＜0.05）,静脉使用环磷酰胺的比例高于动脉僵硬度正常的SLE患者[OR =3.04,95％ CI：1.230 -7.514,P=0.013].（2）对上述混淆因素进行调整后,年龄[OR=4.56,95％ CI：1.863 - 11.130,P=0.000]、平均动脉压[OR=1.12,95％CI：1.055-1.196,P=0.000]、SLE病程[OR=1.20,95％ CI：1.050 -1.367,P =0.007]以及静脉使用环磷酰胺比例[OR=2.86,95％ CI：1.364 -5.979,P=0.005]是SLE患者动脉僵硬度增高的独立危险因素.结论 传统心血管危险因素及SLE特异性相关因素均与SLE患者动脉僵硬度增高相关.

Objective To observe the prevalence and related risk factors of arterial stiffness measured by brachial-ankle pulse wave velocity （baPWV） in patients with systemic lupus erythematosus （SLE）.Methods The study population included 135 patients currently enrolled in the Chinese SLE Treatment and Research group registry （CSTAR）.All traditional cardiovascular risk factors and SLE-related disease factors were collected on the day of the baPWV examination.Results （1） Significant differences were observed in age （P 〈 0.000）,family history of cardiovascular disease （P =0.003）,mean blood pressure （P =0.000） and hemoglobin A1c （P =0.023） between SLE patients with normal and abnormal arterial stiffness.In addition,SLE patients with abnormal arterial stiffness had lower creatinine clearance rates [85.9（65.5-108.8） ml/min vs.106.4 （86.8-124.6） ml/min,P =0.011],longer disease and hydroxychloroquine duration （P =0.002 and P =0.022,respectively）,and higher proportion of intravenous cyclophosphamide use （OR =3.04,95% CI：1.230-7.514,P =0.013） as compared to patients with normal arterial stiffness.（2） After adjustment of all confounding factors,age （OR =4.56,95% CI：1.863-11.133,P =0.001）,mean blood pressure （OR =1.12,95% CI：1.055-1.196,P =0.000）,disease duration （OR =1.12,95% CI：1.050-1.367,P =0.007） and the proportion of intravenous cyclophosphamide use （OR =2.86,95% CI：1.364-5.979,P =0.005） remained as independent risk factors for abnormal arterial stiffness in SLE patients.Conclusion Both traditional cardiovascular risk factors and SLE-related factors are associated with the risk of increased arterial stiffness.