Kao Amy H, Sabatine Janice M, Manzi Susan
University of Pittsburgh School of Medicine, Pennsylvania, USA.
Curr Opin Rheumatol. 2003 Sep;15(5):519-27. doi: 10.1097/00002281-200309000-00001.
Young women with systemic lupus erythematosus have strikingly high rates of coronary heart disease. Current knowledge indicates that atherosclerosis is an active inflammatory and immune-mediated process. Therefore, the chronic inflammation and immune dysregulation characteristic of systemic lupus erythematosus undoubtedly contribute to the accelerated vascular disease seen in these patients. Carefully considering what is known about atherogenesis in the general population will provide clues to unraveling the complexity of why systemic lupus erythematosus and atherosclerosis are linked so frequently.
Inflammation is involved in all aspects of atherogenesis from the initial endothelial "response to injury," to foam cell formation leading to the atherosclerotic lesion, to the rupture of the "vulnerable" fibrous cap, resulting in the acute coronary syndrome and potentially in death. The authors review how factors commonly seen in systemic lupus erythematosus or inherent to the underlying disease mechanism may contribute to each of the stages of atherogenesis.
Our focus on the causes of vascular disease in systemic lupus erythematosus must now include nontraditional risk factors such as immune and inflammatory mediators. With the advent of noninvasive screening tools for atherosclerosis, we are better equipped to measure subclinical vascular disease and associated risk factors, including immune and inflammatory mediators. When considering strategies for preventing premature cardiovascular disease in systemic lupus erythematosus, modifying immune and inflammatory risk factors will likely become a major component of the program in addition to modifying the current traditional risk factors.
患有系统性红斑狼疮的年轻女性患冠心病的几率出奇地高。目前的知识表明，动脉粥样硬化是一个活跃的炎症和免疫介导过程。因此，系统性红斑狼疮所特有的慢性炎症和免疫失调无疑促成了这些患者中出现的血管疾病加速。仔细思考普通人群中已知的动脉粥样硬化发病机制，将为解开系统性红斑狼疮与动脉粥样硬化为何频繁关联的复杂性提供线索。
炎症参与动脉粥样硬化发生的各个方面，从最初的内皮细胞 “损伤反应”，到导致动脉粥样硬化病变的泡沫细胞形成，再到 “易损” 纤维帽的破裂，从而导致急性冠状动脉综合征并可能导致死亡。作者回顾了系统性红斑狼疮中常见的因素或潜在疾病机制所固有的因素可能如何促成动脉粥样硬化发生的各个阶段。
我们目前对系统性红斑狼疮血管疾病病因的关注必须包括免疫和炎症介质等非传统风险因素。随着动脉粥样硬化非侵入性筛查工具的出现，我们有更好的条件来测量亚临床血管疾病及相关风险因素，包括免疫和炎症介质。在考虑预防系统性红斑狼疮患者过早发生心血管疾病的策略时，除了改变当前的传统风险因素外，改变免疫和炎症风险因素可能会成为该计划的一个主要组成部分。
