Schanberg Laura E, Sandborg Christy
Division of Pediatric Rheumatology, Duke University Medical Center, Box 3212, Durham, NC 27710, USA.
Curr Rheumatol Rep. 2004 Dec;6(6):425-33. doi: 10.1007/s11926-004-0021-4.
While modern treatments for systemic lupus erythematosus (SLE) have resulted in greatly improved long term outcome in children and adults, complications of atherosclerosis have become a major cause of morbidity and mortality. Although children and adolescents with SLE rarely experience adverse cardiovascular events before adulthood, dyslipoproteinemia and early evidence of premature atherosclerosis is present much earlier. Accelerated atherogenesis in SLE is multifactorial, most likely reflecting vascular, immune, and inflammatory changes along with medication effects. The long term complications of cardiovascular disease in childhood lupus present a particularly important target for intervention because of the potential return on investment by significantly lengthening life and improving quality of life over many decades. An ongoing multi-center, randomized, controlled trial, Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE), testing the efficacy of statins in preventing premature atherosclerosis in children and adolescents with SLE will guide future therapeutic intervention.
虽然现代系统性红斑狼疮（SLE）治疗方法已使儿童和成人的长期预后得到极大改善，但动脉粥样硬化并发症已成为发病和死亡的主要原因。尽管患有SLE的儿童和青少年在成年前很少经历不良心血管事件，但血脂异常和早期动脉粥样硬化的证据出现得要早得多。SLE中加速的动脉粥样硬化是多因素的，很可能反映了血管、免疫和炎症变化以及药物作用。儿童狼疮中心血管疾病的长期并发症是一个特别重要的干预目标，因为通过显著延长寿命和提高数十年的生活质量，可能会有投资回报。一项正在进行的多中心、随机、对照试验，即儿童狼疮性动脉粥样硬化预防（APPLE）试验，正在测试他汀类药物在预防患有SLE的儿童和青少年过早发生动脉粥样硬化方面的疗效，这将为未来的治疗干预提供指导。
