系统性红斑狼疮中的冠状动脉钙化与传统心血管危险因素相关，但与疾病活动无关。

Coronary calcium in systemic lupus erythematosus is associated with traditional cardiovascular risk factors, but not with disease activity.

作者信息

Kiani Adnan N, Magder Laurence, Petri Michelle

机构信息

Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

J Rheumatol. 2008 Jul;35(7):1300-6. Epub 2008 May 15.

PMID:18484694

Abstract

OBJECTIVE

Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). The frequency of both subclinical and clinically evident atherosclerosis is greatly increased over healthy controls. We assessed cardiovascular risk factors present in patients with SLE at the baseline visit in a statin intervention trial and their correlation with coronary calcium.

METHODS

Coronary calcium was measured by helical computed tomography (continuous volumetric data acquisition in a single breath-hold) in 200 patients with SLE enrolled in the Lupus Atherosclerosis Prevention Study.

RESULTS

Patients had a mean age of 44.3 +/- 11.4 years and were 92% women, 61% Caucasian, 34% African American, 2% Asian, and 2% Hispanic. Coronary calcium was found in 43%. In univariate analysis, coronary calcification was associated with age (p = 0.0001), hypertension (p = 0.0008), body mass index (BMI; p = 0.03), erythrocyte sedimentation rate (ESR; p = 0.03), anti-dsDNA (p = 0.067), and lipoprotein(a) (p = 0.03). Homocysteine (p = 0.050), high-sensitivity C-reactive protein (hsCRP; p = 0.053), and LDL (p = 0.048) had a stronger association when considered as quantitative predictors. In a multiple logistic regression model, only age (p </= 0.0001) and body mass index (p = 0.0014) remained independent predictors. No measure of SLE activity was associated with coronary calcium. We also examined variables independently predictive of a coronary calcium score > 100. Based on a multiple logistic regression model, only age (p = 0.0017) and diabetes mellitus (p = 0.019) remained significant independent predictors of coronary calcium > 100.

CONCLUSION

Inflammation, measured as ESR or hsCRP, is associated with coronary calcium only in univariate analyses. Age, BMI, and diabetes mellitus are more important associates of coronary calcium in SLE than inflammatory markers and SLE clinical activity.

摘要

目的

心血管疾病是系统性红斑狼疮（SLE）发病和死亡的主要原因。与健康对照相比，亚临床和临床明显的动脉粥样硬化发生率均大幅增加。我们在一项他汀类药物干预试验的基线访视中评估了SLE患者存在的心血管危险因素及其与冠状动脉钙化的相关性。

方法

在参与狼疮动脉粥样硬化预防研究的200例SLE患者中，通过螺旋计算机断层扫描（一次屏气连续容积数据采集）测量冠状动脉钙化。

结果

患者的平均年龄为44.3±11.4岁，92%为女性，61%为白种人，34%为非裔美国人，2%为亚洲人，2%为西班牙裔。43%的患者发现有冠状动脉钙化。在单因素分析中，冠状动脉钙化与年龄（p = 0.0001）、高血压（p = 0.0008）、体重指数（BMI；p = 0.03）、红细胞沉降率（ESR；p = 0.03）、抗双链DNA（p = 0.067）和脂蛋白(a)（p = 0.03）相关。当将同型半胱氨酸（p = 0.050）、高敏C反应蛋白（hsCRP；p = 0.053）和低密度脂蛋白（LDL；p = 0.048）视为定量预测指标时，它们的关联性更强。在多因素逻辑回归模型中，只有年龄（p≤0.0001）和体重指数（p = 0.0014）仍然是独立的预测指标。没有任何SLE活动指标与冠状动脉钙化相关。我们还检查了独立预测冠状动脉钙化评分>100的变量。基于多因素逻辑回归模型，只有年龄（p = 0.0017）和糖尿病（p = 0.019）仍然是冠状动脉钙化>100的显著独立预测指标。