系统性红斑狼疮患者白细胞介素18水平与心血管危险因素相关性分析

Relationship of plasma interleukin-18 concentrations to cardiovascular risk factors in patients with systemic lupus erythematosus

目的 研究系统性红斑狼疮(SLE)患者白细胞介素18(IL-18)水平与心血管高危因素的关系,探讨SLE与早期动脉粥样硬化的关系.方法 59例SLE女性患者按IL-18水平分为3组:＜2×107g/L(A组,19例),2.0～3.2× 107g/L(B组,22例),≥3.2× 107g/L(C组,18例),分析患者的体质量指数、收缩压、舒张压、空腹胰岛素、血糖、血脂、踝臂脉搏波速度(baPWV)、血浆同型半胱氨酸(Hcy).结果 A、B、C组血浆胰岛素(F=15.61,P＜0.01)、甘油三酯(F=4.06,P＜0.05)、Hcy(F=11.18,P＜0.01)和胰岛素抵抗指数(IR) (F=8.49,P＜0.01)比较差异均有统计学意义;72.88％的患者存在Hcy血症,导致IL-18水平显著升高(P＜0.05);A、B、C组的随IL-18水平的IR升高而升高(分别为208.75±23.21、261.20±17.82、339.05±32.54,P＜0.01).IL-18水平与SLE危险因素baPWV、胰岛素水平、IR相关(P值分别为0.019、0.002、0.000).结论 SLE患者高胰岛素血症、胰岛素抵抗、同型半胱氨酸血症和血管硬化等协同促进IL-18的升高.

Objective To explore the relationship between interleukin-18 (IL-18) and cardiovascular risk factors in patients with systemic lupus erythematosus (SLE),and between SLE and early atherosclerosis.Method A total of 59 female patients with SLE were divided into three groups according to the level of IL-18:＜2× 107g/L (A group,19 cases),2.0-3.2 × 107 g/L (B group,22 cases),≥ 3.2 × 107 g/L (C group,18 cases).The cardiovascular risk factors including body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting insulin and glucose,plasma glucose,plasma lipid,brachial-ankle pulse wave velocity(baPWV) and plasma homocysteine (Hcy) were determined in all patients.Result Plasma levels of insulin,triglyceride,homocysteine and values of homeostasis model assessment insulin resistance (HOMA IR) in SLE patients with IL-18 ≥3.2×107 g/L were significant higher than patients with IL-1＜2× 107 g/L or 2-3.2 × 107 g/L (F =15.61,4.06,11.18,8.49;P ＜ 0.01 or P ＜ 0.05).About 72.88％ patient had hyperhomocysteinaemia which lead to significantly increase the level of IL-18 (P＜0.05).The level of IL-18 of patients in A,B and C groups were (208.75 ± 23.21),(261.20± 17.82) and (339.05 ± 32.54),and it increased significantly as IL-18 increase (P＜0.05).The level of IL-18 was increased as risk factors of SLE including baPWV,level of insulin and IR increased (P =0.019,0.002,0.000).Conclusion The synergistic effects of hyperinsulinaemia,insulin resistance,hyperhomocysteinaemia and vascular stiffness most likely contribute to the elevation of plasma IL-18 concentrations in patients with SLE.