伴与不伴肾炎的系统性红斑狼疮患者血管内皮功能研究

Study of artery endothelial function in systemic lupus erythematosus patients with and without nephritis

目的通过血管超声探讨伴与不伴肾炎的系统性红斑狼疮(SLE)患者血管内皮功能。方法 SLE患者80例,其中伴肾炎患者40例,超声测量颈动脉内膜中层厚度(CIMT)和肱动脉内皮依赖性舒张(FMD)。将患者按照病程(≥2年和<2年)、SLEDAI评分(≥18分和<18分)、年龄(≥25岁和<25岁)分别分组,比较各组CIMT和FMD差异。结果在所有SLE患者中,CIMT与患者年龄呈正相关(P <0.05),FMD与患者年龄和SLEDAI评分呈负相关(P <0.05),CIMT和FMD在年龄≥25岁的SLE患者中较年龄<25岁的患者更为异常(P <0.05),而SLEDAI评分≥18的患者的FMD低于SLEDAI评分<18的患者(P <0.05)。CIMT在伴与不伴肾炎的SLE患者之间差异无统计学意义(P> 0.05),而FMD在伴有肾炎的SLE患者中低于不伴有肾炎的SLE患者(P <0.05)。在伴有肾炎的SLE患者中,CIMT在年龄≥25岁的SLE患者中高于年龄<25岁的患者(P <0.05),FMD在病程≥2年的患者中低于较病程<2年的患者(P <0.05)。结论合并肾炎的SLE患者发生动脉硬化导致早期器官损伤的危险性较不伴肾炎的SLE患者有更高的危险。早期积极治疗可能防治内皮功能障碍。FMD是一种非侵入性的、可重复的、有效评估血管内皮功能的方法。

Objective To explore the artery endothelial function in systemic lupus erythematosus patients with and without nephritis through vascular ultrasonography.Methods This study recruited 80 consenting SLE patients,including 40 patients with nephritis.We measured baseline laboratory levels,carotid intima media thickness(CIMT)and flow-mediated dilation(FMD).Patients with SLE were divided into groups according to course of disease,score and age.The differences of CIMT and FMD between all groups were compared.Results In all SLE patients,CIMT showed positive correlation(P<0.05),and FMD showed inverse correlation with patient's age(P<0.05).CIMT and FMD were more deranged in patients aged≥25 years(P<0.05).CIMT was not significantly different between SLE patients with and without nephritis(P>0.05),whereas FMD were more deranged in nephritis patients(P<0.05).In nephritis patients,CIMT were more deranged in patients aged≥25 years(P<0.05),and FMD were more deranged in patients with disease duration of≥2 years(P<0.05).Conclusion SLE patients with nephritis are at a higher risk to develop arterial stiffening,leading to early end-organ damage.Early aggressive treatment may prevent endothelial dysfunction.FMD using vascular ultrasonography on the brachial artery represents a non-invasive,repeatable and useful method for the assessment of endothelial dysfunction.