Manger K, Kusus M, Forster C, Ropers D, Daniel W G, Kalden J R, Achenbach S, Manger B
Department of Internal Medicine III and Institute for Clinical Immunology, University Erlangen-Nuremberg, Germany. Department of Internal Medicine II, University Erlangen-Nuremberg, Germany.
Ann Rheum Dis. 2003 Sep;62(9):846-50. doi: 10.1136/ard.62.9.846.
With improved survival rates of patients with systemic lupus erythematosus (SLE), damage such as accelerated atherosclerosis gains increasing importance.
To identify the prevalence of coronary artery calcifications (CAC) in asymptomatic patients.
Electron beam tomography (EBT) was performed in 75 female patients with SLE aged <50. The results were correlated with traditional and SLE related factors associated with CAC. 49 women with symptomatic coronary heart disease (CHD) and 279 women without CHD were also analysed.
Overall, 21/75 (28%) patients had CAC. Low HDL cholesterol levels <1.40 mmol/l (p=0.03, OR=1.8, 67% v 39%) and cigarette smoking (p=0.01, OR=5.7, 76% v 44%) were identified as factors associated with CAC. Hypertension and high cholesterol were more common in women with CHD (p<0.01) than in those without CHD. SLE related factors were proteinuria (1331 v 465 mg/day, p=0.02), impaired renal function (p=0.02, OR=2.6, 26% v 6%), and high C3 levels (p=0.04, OR=1.8, 65% v 38%). High C3 levels were also more common in symptomatic CHD (p=0.02). The prevalence of Sm antibodies was lower in patients with CAC (15% v 42%, p=0.03). In a multivariate analysis, cigarette smoking, reduced renal function, high C3, and a cumulative steroid dose above 30 g were the most important CAC associated factors in the lupus cohort.
A subgroup of patients with SLE with CAC without any clinical symptoms of CHD was identified by EBT. Therefore, EBT is useful for assessing asymptomatic atherosclerosis in this group.
随着系统性红斑狼疮(SLE)患者生存率的提高,诸如动脉粥样硬化加速等损害变得越来越重要。
确定无症状患者冠状动脉钙化(CAC)的患病率。
对75名年龄<50岁的女性SLE患者进行电子束断层扫描(EBT)。将结果与与CAC相关的传统因素和SLE相关因素进行关联分析。还分析了49名有症状冠心病(CHD)的女性和279名无CHD的女性。
总体而言,75名患者中有21名(28%)有CAC。低高密度脂蛋白胆固醇水平<1.40 mmol/l(p=0.03,OR=1.8,67%对39%)和吸烟(p=0.01,OR=5.7,76%对44%)被确定为与CAC相关的因素。高血压和高胆固醇在有CHD的女性中比在无CHD的女性中更常见(p<0.01)。SLE相关因素为蛋白尿(1331对465 mg/天,p=0.02)、肾功能受损(p=0.02,OR=2.6,26%对6%)和高C3水平(p=0.04,OR=1.8,65%对38%)。高C3水平在有症状CHD中也更常见(p=0.02)。Sm抗体的患病率在有CAC的患者中较低(15%对42%,p=0.03)。在多变量分析中,吸烟、肾功能降低、高C3和累积类固醇剂量超过30 g是狼疮队列中与CAC相关的最重要因素。
通过EBT确定了一组无CHD任何临床症状但有CAC的SLE患者。因此,EBT对于评估该组无症状动脉粥样硬化很有用。