系统性红斑狼疮患儿血浆同型半胱氨酸浓度升高。

Increased concentration of plasma homocysteine in children with systemic lupus erythematosus.

作者信息

do Prado R, D'Almeida V M, Guerra-Shinohara E, Galdieri L C, Terreri M T, Hilário M O

机构信息

Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

出版信息

Clin Exp Rheumatol. 2006 Sep-Oct;24(5):594-8.

PMID:17181933

Abstract

OBJECTIVE

Studies in adults with SLE have evidenced increase of homocysteine related, mainly, to thromboembolic events. The aim of our study was to evaluate plasma homocysteine concentration in children with systemic lupus erythematosus (SLE) and its correlation with renal involvement, serum and erythrocyte folate, vitamin B12, antiphospholipid antibodies, estimated creatinine clearance and dyslipidemia.

METHODS

Thirty-two children (29 females) with SLE and 32 healthy controls (29 females) matched for age and sex were included in the study. The mean age of patients and controls was 14.2 years (range from 10 to 18 years). Only one patient presented one thrombotic event. Plasma homocysteine, erythrocyte and serum folate, vitamin B12, lipid profile, antiphospholipid antibodies and estimated creatinine clearance were evaluated. Raised homocysteine concentration was defined as equal or more than 12.9 mol/L.

RESULTS

Raised homocysteine concentration was detected in 15 (46.9%) children with SLE with an important statistical difference in relation to control group (p < 0.001). A positive correlation was found between plasma homocysteine concentration and renal involvement (odds ratio 11.1 [95% CI 1.50-82.24], p = 0.01) based on the presence of renal biopsy, abnormalities of urine sediment and/or serum creatinine. However, when we performed the estimated creatinine clearance the correlation with homocysteine concentration was not positive. We did not observe abnormalities in serum and erythrocyte folate and vitamin B12 in our patients. However, they presented significant higher concentrations of TC total cholesterol (p = 0.005) and of LDL low-density lipoprotein (p = 0.02) than controls.

CONCLUSION

Elevated plasma homocysteine concentration is frequent in children with SLE. We believe that these results may signalize to the possibility of complications in our patients later in life. Further long-term and prospective studies are needed in order to determine the real role of the homocysteine concentration as a risk factor in children.

摘要

目的

针对成年系统性红斑狼疮（SLE）患者的研究表明，同型半胱氨酸水平升高主要与血栓栓塞事件相关。我们研究的目的是评估儿童系统性红斑狼疮（SLE）患者血浆同型半胱氨酸浓度，并探讨其与肾脏受累情况、血清及红细胞叶酸、维生素B12、抗磷脂抗体、估计肌酐清除率和血脂异常之间的相关性。

方法

本研究纳入了32例SLE患儿（29例女性）以及32例年龄和性别相匹配的健康对照儿童（29例女性）。患者和对照的平均年龄为14.2岁（范围为10至18岁）。仅1例患者发生过一次血栓事件。评估了血浆同型半胱氨酸、红细胞和血清叶酸、维生素B12、血脂谱、抗磷脂抗体以及估计肌酐清除率。同型半胱氨酸浓度升高定义为等于或高于12.9 μmol/L。

结果

15例（46.9%）SLE患儿检测到同型半胱氨酸浓度升高，与对照组相比存在显著统计学差异（p < 0.001）。基于肾活检结果、尿沉渣异常和/或血清肌酐情况，发现血浆同型半胱氨酸浓度与肾脏受累之间存在正相关（优势比11.1 [95%可信区间1.50 - 82.24]，p = 0.01）。然而，当我们计算估计肌酐清除率时，其与同型半胱氨酸浓度并无正相关。我们的患者血清及红细胞叶酸和维生素B12未见异常。然而，他们的总胆固醇（TC）（p = 0.005）和低密度脂蛋白（LDL）（p = 0.02）浓度显著高于对照组。