Systemic Autoimmune Diseases Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain.
J Rheumatol. 2009 Oct;36(10):2204-11. doi: 10.3899/jrheum.081253. Epub 2009 Sep 1.
Aortic pulse wave velocity (PWV) is an independent predictor of risk for atherosclerotic cardiovascular disease. Metabolic syndrome (MetS) is more prevalent in patients with systemic lupus erythematosus (SLE) compared with matched healthy subjects. Aortic PWV is increased in MetS. The purpose of this cross-sectional study was to determine the association between MetS and aortic PWV and other surrogate biomarkers of subclinical atherosclerosis in SLE.
One hundred twenty-eight patients with SLE were studied. We established the presence of MetS according to the National Cholesterol Education Program Adult Treatment Panel III definition and we measured PWV, glucose, insulin, glycosylated hemoglobin (HbA(1c)), insulin sensitivity (HOMA index), lipid levels, uric acid, homocysteine, fibrinogen, D-dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin 6 (IL-6), IL-8, IL-10, C3, C4, autoantibodies, SLE Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinics/ACR Damage Index. Duration of SLE and treatment was also recorded. Multivariate logistic regression analysis was used to identify independent determinants of increased PWV.
SLE patients with MetS had higher aortic PWV (9.8 +/- 2.4 vs 8.5 +/- 1.7 m/s; p = 0.002) and increased biomarkers of subclinical atherosclerosis such as CRP, IL-6, C3, uric acid, homocysteine, fibrinogen and D-dimer, compared to those without MetS. HOMA index and insulin and HbA(1c) levels were also higher in this group. No differences were found in variables related to lupus activity (ESR, C4, SLEDAI, IL-8, IL-10, and treatment for SLE). In the multivariate model, increased PWV was associated with age, male sex, MetS, duration of SLE, and CRP.
MetS may contribute to the development of accelerated atherosclerosis in SLE.
脉搏波速度（PWV）是动脉粥样硬化性心血管疾病风险的独立预测因子。与匹配的健康受试者相比，代谢综合征（MetS）在系统性红斑狼疮（SLE）患者中更为普遍。MetS 患者的主动脉 PWV 增加。本横断面研究的目的是确定 MetS 与主动脉 PWV 以及 SLE 亚临床动脉粥样硬化的其他替代生物标志物之间的关系。
研究了 128 例 SLE 患者。我们根据国家胆固醇教育计划成人治疗小组 III 定义确定 MetS 的存在，并测量了 PWV、血糖、胰岛素、糖化血红蛋白（HbA1c）、胰岛素敏感性（HOMA 指数）、血脂水平、尿酸、同型半胱氨酸、纤维蛋白原、D-二聚体、C 反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、白细胞介素 10（IL-10）、C3、C4、自身抗体、SLE 疾病活动指数（SLEDAI）和系统性红斑狼疮国际合作诊所/ACR 损害指数。还记录了 SLE 的持续时间和治疗情况。采用多变量 logistic 回归分析确定 PWV 升高的独立决定因素。
患有 MetS 的 SLE 患者的主动脉 PWV 更高（9.8+/-2.4 与 8.5+/-1.7 m/s；p=0.002），并且亚临床动脉粥样硬化的生物标志物如 CRP、IL-6、C3、尿酸、同型半胱氨酸、纤维蛋白原和 D-二聚体也更高，与没有 MetS 的患者相比。该组的 HOMA 指数和胰岛素及 HbA1c 水平也更高。在与狼疮活动相关的变量（ESR、C4、SLEDAI、IL-8、IL-10 和 SLE 治疗）方面没有差异。在多变量模型中，PWV 增加与年龄、男性、MetS、SLE 持续时间和 CRP 相关。
MetS 可能导致 SLE 患者加速动脉粥样硬化的发生。
