高血压与高同型半胱氨酸血症的交互作用对系统性红斑狼疮患者颈动脉粥样硬化的影响

Effect of interaction between hypertension and hyperhomocysteinemia on carotid atherosclerosis in patients with systemic lupus erythematosus

目的高血压与高同型半胱氨酸血症的交互作用对系统性红斑狼疮(SLE)患者颈动脉粥样硬化的影响.方法选择2019年2月至2020年10月在桂林医学院附属医院住院的209例SLE患者作为研究对象.收集患者的临床资料,包括人口学特征、SLE病程、体质量指数(BMI)、同型半胱氨酸(Hcy)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、纤维蛋白原(Fib)、尿酸、补体C3和C4、SLE疾病活动度指数(SLEDAI)评分、血清抗双链DNA(抗dsDNA)抗体、抗Sm抗体、抗干燥综合征B(抗SSB)抗体、抗核糖体P蛋白(抗RNP)抗体和肾脏损害、高血压、糖尿病、血脂异常患者的比例等资料.根据颈动脉彩色B超检查结果将患者分为SLE颈动脉粥样硬化组(31例)和对照组(178例),比较两组上述指标的差异.采用Pearson相关性分析法分析性别、年龄、SLE病程、BMI、Hcy、ESR、CRP、Fib、尿酸、补体C3和C4、SLEDAI评分、抗dsDNA抗体、抗Sm抗体、抗SSB抗体、抗RNP抗体及肾脏损害、高血压、糖尿病、血脂异常与SLE患者颈动脉粥样硬化的相关性.采用Logistic回归模型分析影响SLE患者颈动脉粥样硬化的独立危险因素,应用相加模型及相乘模型对危险因素间的交互作用进行定量分析.结果SLE颈动脉粥样硬化组患者年龄、Hcy、ESR、SLEDAI评分及高血压、糖尿病、血脂异常的患者比例均明显高于对照组[年龄(岁):48(27~66)比37(18~84),Hcy(μmol/L):15.20(4.20~25.00)比9.80(3.60~22.70),ESR(mm/1 h):55(3~133)比28(2~120),SLEDAI评分(分):6(2~16)比4(0~22),高血压患者比例:45.2%(14/31)比10.7%(19/178),糖尿病患者比例:19.4%(6/31)比4.5%(8/178),血脂异常患者比例:35.5%(11/31)比14.0%(25/178),均P<0.05].单因素Logistic回归分析显示:高血压及高Hcy血症同时存在时SLE患者颈动脉粥样硬化的患病风险为无高血压及Hcy正常者的39.704倍[优势比(OR)=39.704,95%可信区间(95%CI)为8.960~175.937],协同效应指数为4.64,相对超额危险度(RERI)为30.357,归因交互效应百分比为76%.控制混杂因素后,多因素Logistic回归分析显示:高血压及高Hcy血症同时存在时SLE患者颈动脉粥样硬化的患病风险为无高血压及Hcy正常者的33.786倍(OR=33.786,95%CI为6.452~176.938),协同效应指数为3.29,RERI为22.835,归因交互效应百分比为68%.结论高血压及高Hcy血症的正交互作用是SLE患者颈动脉粥样硬化的重要危险因素之一,两者共同存可显著增加患病风险.

Objective To investigate the effect of the interaction between hypertension and hyperhomocysteinemia on carotid atherosclerosis in systemic lupus erythematosus(SLE).Methods A total of 209 SLE patients hospitalized admitted to Affiliated Hospital of Guilin Medical College from February 2019 to October 2020 were selected as the research subjects.Collect clinical data of patients,including demography characteristics,SLE course of disease,body mass index(BMI),homocysteine(Hcy),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),fibrinogen(Fib),uric acid(UA),complement C3 and C4,SLE disease activity index(SLEDAI)score,serum anti-double-stranded DNA(anti-dsDNA)antibody,anti-Sm antibody,anti-SjOgren syndrome B(anti-SSB)antibody,anti-ribosomal P protein(anti-RNP)antibodies,and the proportion of patients with kidney damage,hypertension,diabetes,and dyslipidemia.According to the results of carotid artery color B ultrasound examination,they were divided into carotid atherosclerosis group(n=31)and control group(n=178),and the differences of the above indexes between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between sex,age,SLE course of disease,BMI,Hcy,ESR,CRP,Fib,UA,complement C3 and C4,SLEDAI score,anti-dsDNA antibody,anti-Sm antibody,anti-SSB antibody,anti-RNP antibody,kidney damage hypertension,diabetes,dyslipidemia,and carotid atherosclerosis in SLE patients.The independent effects of risk factors were studied by Logistic regression model,and the interaction between risk factors was analyzed by additive model and multiplicative model.Results The age,Hcy,ESR,SLEDAI score,prevalence of hypertension,diabetes,and dyslipidemia in the carotid atherosclerosis group were significantly higher than those in the control group[age(years):48(27-66)vs.37(18-84),Hcy(μmol/L):15.20(4.20-25.00)vs.9.80(3.60-22.70),ESR(mm/1 h):55(3-133)vs.28(2-120),SLEDAI score 6(2-16)vs.4(0-22),prevalence of hypertension:45.2%(14/31)vs.10.7%(19/178),prevalence of diabetes:19.4%(6/31)vs.4.5%(8/178),prevalence of dyslipidemia:35.5%(11/31)vs.14.0%(25/178),all P<0.05].Results of univariate Logistic regression analysis:the risk of carotid atherosclerosis in SLE patients with hypertension and hyperhomocysteinemia was 39.704 times higher than that in SLE patients without hypertension and normal Hcy[odds ratio(OR)=39.704,95%confidence interval(95%CI)was 8.960-175.937],the synergistic effect index was 4.64,the relative excess risk of interaction(RERI)was 30.357,and the attributable proportion due to interaction was 76%.After controing for confounding factors,multivariate Logistic regression analysis showed that the risk of carotid atherosclerosis in SLE patients with hypertension and hyperhomocysteinemia was 33.786 times higher than those without hypertension and normal Hcy(OR=33.786,95%CI was 6.452-176.938),synergistic effect index was 3.29,RERI was 22.835,attributable proportion due to interaction was 68%.Conclusion The positive interaction of hypertension and hyperhomocysteinemia is one of the important risk factors for carotid atherosclerosis in SLE patients,the coexistence of hypertension and hyperhomocysteinemia can significantly increase the risk of carotid atherosclerosis.