长病程低疾病活动度系统性红斑狼疮患者心血管疾病危险因素分析

Cardiovascular Disease Risk Factors in Patients with Systemic Lupus Erythematosus with Long Disease Course and Low Disease Activity

目的比较Framingham评分与QRISK3预测算法评估病程长且病情稳定的系统性红斑狼疮(SLE)患者罹患心血管疾病的风险的有效性,探索该类患者临床特征及心血管疾病危险因素。方法本研究为横断面研究,以2020年6月至2021年1月郑州大学第一附属医院风湿免疫科门诊诊治的92例病程长且病情稳定的SLE患者为研究对象。运用Framingham评分和QRISK3算法评估患者的心血管疾病危险因素,分析评价效果的差异,根据评估效果较好的方法分组进行心血管疾病危险因素分析。结果Framingham指数报告的中位风险评分为2.4%(3.9%,1.5%),6例(6.5%)患者被判定为高心血管疾病风险;QRISK3指数报告的中位风险评分为3.9%(7.0%,1.7%),18例(19.6%)患者被判定为高心血管疾病风险。根据QRISK3算法评估结果进行分组,高心血管疾病风险组患者年龄更大(P=0.001),总胆固醇水平(P=0.030)和甘油三酯水平(P=0.005)更高,代谢综合征发生率更高(P=0.001),初诊时系统性红斑狼疮疾病活动度评分2000(SLEDAI-2K)评分更高(P=0.038),羟氯喹日剂量更小(P=0.041)。结论对于长病程且控制良好的SLE患者,QRISK3算法较Framingham评分能识别出更多的高心血管疾病风险者,其心血管疾病危险因素包括年龄、血脂水平、代谢综合征以及初诊时的疾病活动度,羟氯喹是一项保护性因素。

Objective To compare the effectiveness of Framingham score and QRISK3 prediction algorithm in assessing the risk of cardiovascular disease in patients with systemic lupus erythematosus(SLE)with long disease course and low disease activity,and to explore the clinical characteristics and risk factors of cardiovascular disease in such patients.Methods This study was a cross-sectional study.Ninety-two patients with SLE with long course and low disease activity who were diagnosed and treated from June 2020 to January 2021 in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhengzhou University were the subjects of study.Framingham score and QRISK3 algorithm were used to evaluate the risk factors of cardiovascular disease in the patients,and the difference in evaluation effect was analyzed.According to the method with better evaluation effect,the patients were divided into groups to analyze the risk factors of cardiovascular disease.Results The median risk score reported by the Framingham index was 2.4%(3.9%,1.5%),and 6 patients(6.5%)were judged to be at high risk of cardiovascular disease.The median risk score reported by the QRISK3 index was 3.9%(7.0%,1.7%),and 18 patients(19.6%)were judged to be at high risk of cardiovascular disease.The patients were grouped according to the QRISK3 algorithm.Among patients at high risk of cardiovascular disease,the age was older(P=0.001),the total cholesterol level(P=0.030)and triglyceride level(P=0.005)were higher,the incidence of metabolic syndrome was higher(P=0.001),the systemic lupus erythematosus disease activity index 2000(SLEDAI-2K)score was higher at the first visit(P=0.038),and the daily dose of hydroxychloroquine was lower(P=0.041).Conclusions For SLE patients with long course and well-controlled disease,the QRISK3 algorithm could identify more people at high risk of cardiovascular disease than Framingham score.The risk factors for cardiovascular disease include age,blood lipid level,metabolic syndrome,and disease activity at first diagnosis.The hydroxychloroquine is a protective factor.