Maksimowicz-McKinnon Kathleen, Magder Laurence S, Petri Michelle
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Rheumatol. 2006 Dec;33(12):2458-63. Epub 2006 Oct 1.
Patients with systemic lupus erythematosus (SLE) are at increased risk for cardiovascular and cerebrovascular events, even after adjustment for traditional risk factors. We examined the association of traditional risk factors, novel markers of cardiovascular disease (C-reactive protein, homocysteine, lipoprotein(a), plasminogen activator inhibitor-1, fibrinogen), and markers indicative of SLE activity (including C3, C4, anti-dsDNA, and prednisone use) with the presence of significant plaque on carotid duplex imaging.
Six hundred five patients with SLE enrolled in the Hopkins Lupus Cohort Study (92% female, 38% African-American) underwent carotid duplex testing. Prospectively gathered clinical, laboratory, and serologic data from their quarterly followup visits in the Hopkins Lupus Cohort were used in the analyses. For predictors that varied over time, such as cholesterol, the mean values during cohort participation were calculated for the analysis. Informed consent was obtained from all patients.
The presence of carotid plaque was strongly associated with age, ranging from 1% among those less than 30 years of age to 61% among those 60 years or older. After adjusting for age, there were moderate or strong associations of carotid plaque with male gender (age-adjusted risk 25% vs 13%; p = 0.051), hypertension (age-adjusted risk 18% vs 8%; p = 0.0001), diabetes mellitus (age-adjusted risk 19% vs 13%; p = 0.075), C3 > 120 mg/dl (age-adjusted risk 18% vs 11% and 14% for normal and low C3, respectively; p = 0.046), serum creatinine > 1.3 (age-adjusted risk 32% vs 13%; p = 0.039), and mean systolic blood pressure > 140 (age-adjusted risk 23% vs 13%; p = 0.028). There was no strong evidence of an association between plaque and SLE disease activity (age-adjusted risk 14% among those with adjusted mean SLEDAI > 3 vs 14% among those with lower SLEDAI) or with time since SLE diagnosis (age-adjusted risk 12%, 14%, and 16% among those with SLE for < 2, 2-8, and > 8 years, respectively; p = 0.49).
Traditional cardiovascular risk factors were associated with carotid plaque in SLE. However, SLE disease activity and duration of SLE are not strongly associated with carotid plaque. A "lupus factor" separate from traditional risk factors remains unidentified.
系统性红斑狼疮（SLE）患者发生心血管和脑血管事件的风险增加，即便在对传统风险因素进行校正之后亦是如此。我们研究了传统风险因素、心血管疾病新标志物（C反应蛋白、同型半胱氨酸、脂蛋白(a)、纤溶酶原激活物抑制剂-1、纤维蛋白原）以及提示SLE活动的标志物（包括C3、C4、抗双链DNA和泼尼松的使用）与颈动脉双功超声成像显示的显著斑块之间的关联。
605例参与霍普金斯狼疮队列研究的SLE患者（92%为女性，38%为非裔美国人）接受了颈动脉双功超声检查。分析中使用了从他们在霍普金斯狼疮队列每季度随访中前瞻性收集的临床、实验室和血清学数据。对于随时间变化的预测因素，如胆固醇，计算队列参与期间的平均值用于分析。所有患者均获得了知情同意。
颈动脉斑块的存在与年龄密切相关，年龄小于30岁者中斑块存在率为1%，60岁及以上者中为61%。在对年龄进行校正后，颈动脉斑块与男性（年龄校正风险25%对13%；p = 0.051）、高血压（年龄校正风险18%对8%；p = 0.0001）、糖尿病（年龄校正风险19%对13%；p = 0.075）、C3>120mg/dl（年龄校正风险18%，正常和低C3者分别为11%和14%；p = 0.046）、血清肌酐>1.3（年龄校正风险32%对13%；p = 0.039）以及平均收缩压>140（年龄校正风险23%对13%；p = 0.028）存在中度或强关联。没有强有力的证据表明斑块与SLE疾病活动（校正后平均SLEDAI>3者中年龄校正风险为14%，SLEDAI较低者中为14%）或自SLE诊断后的时间（SLE病程<2年、2 - 8年和>8年者中年龄校正风险分别为12%、14%和16%；p = 0.49）之间存在关联。
传统心血管风险因素与SLE患者的颈动脉斑块相关。然而，SLE疾病活动和SLE病程与颈动脉斑块并无强关联。尚未发现独立于传统风险因素的“狼疮因素”。
