Vaudo Gaetano, Bocci Elena Bartoloni, Shoenfeld Yehuda, Schillaci Giuseppe, Wu Ruihua, Del Papa Nicoletta, Vitali Claudio, Delle Monache Francesco, Marchesi Simona, Mannarino Elmo, Gerli Roberto
University of Perugia, Perugia, Italy.
Arthritis Rheum. 2005 Dec;52(12):3890-7. doi: 10.1002/art.21475.
Systemic lupus erythematosus and rheumatoid arthritis represent independent risk factors for atherosclerosis (ATS), although this may be confounded by continuous pharmacologic treatment. Primary Sjögren's syndrome (SS) shares several features of these diseases and may therefore represent an interesting model for verifying the presence of accelerated ATS in the absence of pharmacologic interference. The present study therefore used this model to describe the presence of accelerated ATS in a group of young women.
Thirty-seven untreated white women with primary SS were evaluated clinically and serologically. Carotid and femoral artery intima-media thickness (IMT) was evaluated in the patients and in 35 age-matched healthy women who served as controls.
The patients had a higher IMT than did the controls at both the carotid (mean +/- SD 0.82 +/- 0.24 mm versus 0.63 +/- 0.20 mm; P < or = 0.001) and the femoral (0.81 +/- 0.26 mm versus 0.67 +/- 0.23 mm; P < or = 0.019) levels, and had a higher prevalence of carotid intima-media thickening (49% versus 11% of controls; P < or = 0.001). The patient subset with high carotid IMT showed an increased prevalence of leukopenia and circulating anti-SSA antibodies; interestingly, the number of leukocytes was inversely correlated with the level of arterial IMT in patients with SS. Multivariate analysis demonstrated that anti-SSA antibodies were independent predictors of carotid artery thickening, while leukopenia was a predictor of both carotid and femoral artery thickening.
Subclinical ATS was evident in about one-half of the patients with SS. Its association with some features typical of connective tissue diseases, such as the presence of anti-SSA and leukopenia, suggests that the immune dysregulation characterizing this autoimmune disorder may play a key role in inducing early ATS.
系统性红斑狼疮和类风湿关节炎是动脉粥样硬化（ATS）的独立危险因素，尽管这可能会被持续的药物治疗所混淆。原发性干燥综合征（SS）具有这些疾病的若干特征，因此可能是在无药物干扰情况下验证是否存在加速ATS的一个有趣模型。因此，本研究使用该模型来描述一组年轻女性中加速ATS的存在情况。
对37名未经治疗的原发性SS白人女性进行临床和血清学评估。对患者以及35名年龄匹配的健康女性（作为对照）进行颈动脉和股动脉内膜中层厚度（IMT）评估。
患者在颈动脉（平均±标准差 0.82±0.24毫米对0.63±0.20毫米；P≤0.001）和股动脉（0.81±0.26毫米对0.67±0.23毫米；P≤0.019）水平的IMT均高于对照组，且颈动脉内膜中层增厚的患病率更高（49%对对照组的11%；P≤0.001）。颈动脉IMT高的患者亚组白细胞减少症和循环抗SSA抗体的患病率增加；有趣的是，SS患者中白细胞数量与动脉IMT水平呈负相关。多变量分析表明，抗SSA抗体是颈动脉增厚的独立预测因素，而白细胞减少症是颈动脉和股动脉增厚的预测因素。
约一半的SS患者存在亚临床ATS。它与结缔组织疾病的一些典型特征相关，如抗SSA的存在和白细胞减少症，这表明这种自身免疫性疾病的免疫失调可能在诱导早期ATS中起关键作用。
