Perna Michelle, Roman Mary J, Alpert Deborah R, Crow Mary K, Lockshin Michael D, Sammaritano Lisa, Devereux Richard B, Cooke John P, Salmon Jane E
Weill Cornell Medical College and Hospital for Special Surgery, New York, New York 10021, USA.
Arthritis Rheum. 2010 Jun;62(6):1718-22. doi: 10.1002/art.27392.
Systemic lupus erythematosus (SLE) is independently associated with accelerated atherosclerosis and premature arterial stiffening. Asymmetric dimethylarginine (ADMA) and homocysteine are mechanistically interrelated mediators of endothelial dysfunction and correlates of atherosclerosis in the general population. The aim of this study was to assess the relationship of ADMA and homocysteine to subclinical vascular disease in patients with SLE.
One hundred twenty-five patients with SLE who were participating in a study of cardiovascular disease underwent clinical and laboratory assessment, carotid artery ultrasonography to detect atherosclerosis, and radial artery applanation tonometry to measure arterial stiffness.
Neither ADMA nor homocysteine correlated with the presence or extent of carotid atherosclerosis. In contrast, ADMA was significantly related to the arterial stiffness index. Independent correlates of arterial stiffening included the ADMA concentration, the presence of diabetes mellitus, older age at the time of diagnosis, longer disease duration, and the absence of anti-Sm or anti-RNP antibodies. A secondary multivariable analysis substituting homocysteine for ADMA demonstrated comparable relationships with arterial stiffness (r(2) = 0.616 for homocysteine and r(2) = 0.595 for ADMA).
ADMA and homocysteine are biomarkers for and may be mediators of premature arterial stiffening in patients with SLE. Because arterial stiffness has independent prognostic value for cardiovascular morbidity and mortality, its predictors may identify patients who are at increased risk of cardiovascular disease.
系统性红斑狼疮（SLE）与动脉粥样硬化加速和动脉过早僵硬独立相关。不对称二甲基精氨酸（ADMA）和同型半胱氨酸是内皮功能障碍的机制相关介质，也是一般人群中动脉粥样硬化的相关因素。本研究的目的是评估ADMA和同型半胱氨酸与SLE患者亚临床血管疾病的关系。
125例参与心血管疾病研究的SLE患者接受了临床和实验室评估、用于检测动脉粥样硬化的颈动脉超声检查以及用于测量动脉僵硬程度的桡动脉压平式眼压测量法。
ADMA和同型半胱氨酸均与颈动脉粥样硬化的存在或程度无关。相比之下，ADMA与动脉僵硬指数显著相关。动脉僵硬的独立相关因素包括ADMA浓度、糖尿病的存在、诊断时年龄较大、病程较长以及缺乏抗Sm或抗RNP抗体。用同型半胱氨酸替代ADMA的二次多变量分析显示与动脉僵硬有类似关系（同型半胱氨酸的r² = 0.616，ADMA的r² = 0.595）。
ADMA和同型半胱氨酸是SLE患者过早动脉僵硬的生物标志物，且可能是其介质。由于动脉僵硬对心血管发病率和死亡率具有独立的预后价值，其预测因素可能识别出心血管疾病风险增加的患者。
