de Carvalho Jozélio Freire, Bonfá Eloísa, Bezerra Mailze C, Pereira Rosa Maria Rodrigues
Rheumatology Division, Faculdade de Medicina e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Clin Rheumatol. 2009 Jul;28(7):801-5. doi: 10.1007/s10067-009-1153-8. Epub 2009 Mar 13.
The objective of this study is to characterize the lipoprotein risk levels in Takayasu arteritis (TA) patients and its possible association with disease activity and glucocorticoid use. Twenty-five female TA patients were consecutively included and compared with 30 age-, gender-, and body mass index-matched healthy controls. Demographic features and the lipid profile were determined and cardiovascular risk levels were evaluated according to NCEP/ATPIII. Total cholesterol (TC), LDL-c, HDL-c, and triglycerides were determined after a 12-h overnight fast. Exclusion criteria were conditions that interfere in the lipid profile. The disease duration was 6.6 +/- 7.4 years; 30% had clinical activity and 80% had laboratory activity. Regarding NCEP/ATPIII risk levels, TA patients presented higher frequency of lipid risk compared to controls: high TC (48% vs. 20%, p = 0.04), low HDL-c (20% vs. 0%, p = 0.015), and high triglycerides (36% vs. 10%, p = 0.026). No difference was observed related to LDL-c risk levels between both groups (40% vs. 20%, p = 0.14). Remarkably, 60% of the patients had at least one lipid risk factor for cardiovascular disease. No difference in the lipids was observed between patients with and without clinical activity; however, those with laboratory activity showed lower levels of HDL-c (1.37 +/- 0.42 vs. 2.00 +/- 0.63 mmol/L, p = 0.012) than patients without this activity. A negative correlation was found between HDL-c and CRP levels (r = -0.42, p = 0.04). Lipids were similar in patients under glucocorticoid compared to those without this therapy. This is the first study to identify that TA, an inflammatory disease, has a proatherogenic lipid profile which is associated to laboratory disease activity.
本研究的目的是描述大动脉炎(TA)患者的脂蛋白风险水平及其与疾病活动和糖皮质激素使用的可能关联。连续纳入25例女性TA患者,并与30例年龄、性别和体重指数相匹配的健康对照者进行比较。确定人口统计学特征和血脂谱,并根据美国国家胆固醇教育计划成人治疗组第三次报告(NCEP/ATPIII)评估心血管风险水平。在禁食12小时过夜后测定总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、高密度脂蛋白胆固醇(HDL-c)和甘油三酯。排除标准为干扰血脂谱的情况。疾病持续时间为6.6±7.4年;30%有临床活动,80%有实验室活动。关于NCEP/ATPIII风险水平,与对照组相比,TA患者出现血脂风险的频率更高:高TC(48%对20%,p=0.04)、低HDL-c(20%对0%,p=0.015)和高甘油三酯(36%对10%,p=0.026)。两组之间在LDL-c风险水平方面未观察到差异(40%对20%,p=0.14)。值得注意的是,60%的患者至少有一项心血管疾病的血脂风险因素。有临床活动和无临床活动的患者之间在血脂方面未观察到差异;然而,有实验室活动的患者的HDL-c水平(1.37±0.42对2.00±0.63 mmol/L,p=0.012)低于无此活动的患者。发现HDL-c与C反应蛋白(CRP)水平之间存在负相关(r=-0.42,p=0.04)。与未接受这种治疗的患者相比,接受糖皮质激素治疗的患者的血脂相似。这是第一项确定TA这种炎症性疾病具有促动脉粥样硬化的血脂谱且与实验室疾病活动相关的研究。