Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan.
Cardiovasc Pathol. 2011 Jan-Feb;20(1):e1-7. doi: 10.1016/j.carpath.2010.01.003. Epub 2010 Feb 4.
Aortic aneurysms including dissection are uncommon complications of systemic lupus erythematosus, but the incidence has been increasing with an improved prognosis for this disease. However, the mechanisms contributing to aneurysm formation in systemic lupus erythematosus have not been fully clarified.
A meta-analysis of published cases was conducted to clarify the patient characteristics that may contribute to aneurysm formation in systemic lupus erythematosus. A search of relevant studies published over the past 40 years (1969-2008) was carried out in the publications on aortic aneurysms with systemic lupus erythematosus, and 35 cases were identified. The contributing factors to aneurysm formation as well as the patient prognosis were searched for sex, age, duration of corticosteroid treatment, aneurysm site (thoracic and/or abdominal), mortality, evidence of atherosclerotic involvement, and presence or absence of an operation, rupture, dissection, cystic medial degeneration, vasculitis, and hypertension. Each of these factors was assigned to each point score. Based on the point scores, a statistical analysis of rank correlation was thereafter performed.
The factors correlating with the presence of thoracic or abdominal lesions differed significantly. The presence of thoracic aneurysms correlated with dissection and cystic medial degeneration, whereas abdominal lesions correlated with the finding of atherosclerosis. Thoracic lesions showed a high rate of death, while abdominal lesions were associated with a relatively favorable prognosis. Abdominal lesions were related to the duration of steroid therapy. The other correlations among the various factors were also evaluated, with the finding of cystic medial degeneration associated with vasculitis.
Two principal patterns emerged from this analysis. One was the fatal nonatherosclerotic thoracic aneurysm which was associated with cystic medial degeneration and probably due to vasculitis. The other was atherosclerotic abdominal aneurysm which was complicated by long-term steroid treatment and it showed a relatively favorable prognosis.
包括夹层在内的主动脉瘤是系统性红斑狼疮的罕见并发症，但随着该病预后的改善，其发病率有所增加。然而，导致系统性红斑狼疮中动脉瘤形成的机制尚未完全阐明。
对已发表的病例进行了荟萃分析，以阐明可能导致系统性红斑狼疮中动脉瘤形成的患者特征。对过去 40 年（1969-2008 年）发表的关于主动脉瘤伴系统性红斑狼疮的文献进行了系统性搜索，并确定了 35 例。搜索了动脉瘤形成的促成因素以及患者预后，包括性别、年龄、皮质类固醇治疗时间、动脉瘤部位（胸和/或腹）、死亡率、动脉粥样硬化受累的证据、是否存在手术、破裂、夹层、囊性中层变性、血管炎和高血压。将这些因素中的每一个分配给一个点分数。在此基础上，对秩相关进行了统计学分析。
与胸或腹病变存在相关的因素有显著差异。胸动脉瘤与夹层和囊性中层变性相关，而腹病变与动脉粥样硬化的发现相关。胸病变死亡率高，而腹病变预后相对较好。腹病变与皮质类固醇治疗时间有关。还评估了各因素之间的其他相关性，发现血管炎与囊性中层变性有关。
从这项分析中出现了两种主要模式。一种是致命的非动脉粥样硬化性胸动脉瘤，与囊性中层变性有关，可能与血管炎有关。另一种是动脉粥样硬化性腹动脉瘤，与长期皮质类固醇治疗有关，预后相对较好。
