Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, National University of Singapore, Singapore.
J Rheumatol. 2011 Jul;38(7):1296-303. doi: 10.3899/jrheum.101182. Epub 2011 Apr 1.
To assess whether endothelium-dependent and endothelium-independent flow-mediated dilation (FMD) are impaired in patients with systemic lupus erythematosus (SLE) with no history of vascular event; and to determine factors moderating impaired FMD in SLE.
Electronic databases were searched for case-control studies that compared endothelium-dependent and/or endothelium-independent FMD at the brachial artery between SLE patients who were naive for vascular events and matched healthy controls. Effect size as standardized mean difference (SMD) and 95% confidence intervals of FMD between SLE patients and controls was pooled using the inverse variance method. Mixed-model metaregression was performed to identify potential demographic and clinical factors associated with the effect size.
Thirteen relevant studies involving 580 patients and 381 matched healthy controls were included. Endothelium-dependent FMD was significantly lower in SLE patients than in controls (SMD -0.832, 95% CI -1.172 to -0.492, p < 0.001). Endothelium-independent FMD, however, did not differ between the 2 groups (SMD -0.179, 95% CI -0.433 to 0.075, p = 0.167). Metaregression revealed that increasing age (r = 0.047, p = 0.037) and duration of SLE (r = 0.008, p = 0.024) at the time of FMD measurement significantly narrowed the difference of endothelium-dependent FMD between patients and controls; whereas sex, smoking, menopause, diabetes mellitus, body mass index, blood pressure, fasting lipid profile, C-reactive protein, and prednisolone use did not.
Endothelium-dependent, but not endothelium-independent FMD is significantly impaired in lupus patients who are naive for vascular events. Increasing age and longer disease duration may limit the potential of endothelial reactivity as an indicator of early atherosclerosis in SLE.
评估无血管事件史的系统性红斑狼疮（SLE）患者是否存在内皮依赖性和非内皮依赖性血流介导的舒张功能（FMD）受损，并确定调节 SLE 中 FMD 受损的因素。
电子数据库检索了比较无血管事件史的 SLE 患者和匹配的健康对照者肱动脉内皮依赖性和/或非内皮依赖性 FMD 的病例对照研究。使用逆方差法汇总 SLE 患者和对照组之间 FMD 的效应大小（标准化均数差 [SMD]）和 95%置信区间。采用混合模型荟萃回归分析确定与效应大小相关的潜在人口统计学和临床因素。
纳入了 13 项涉及 580 例患者和 381 例匹配健康对照者的相关研究。SLE 患者的内皮依赖性 FMD 明显低于对照组（SMD -0.832，95%CI -1.172 至 -0.492，p < 0.001）。然而，两组间的非内皮依赖性 FMD 无差异（SMD -0.179，95%CI -0.433 至 0.075，p = 0.167）。荟萃回归显示，FMD 测量时的年龄增加（r = 0.047，p = 0.037）和 SLE 病程（r = 0.008，p = 0.024）与患者和对照组之间内皮依赖性 FMD 的差异缩小显著相关；而性别、吸烟、绝经、糖尿病、体重指数、血压、空腹血脂谱、C 反应蛋白和泼尼松龙的使用则没有。
无血管事件史的狼疮患者，其内皮依赖性 FMD 明显受损，而非内皮依赖性 FMD 则无明显受损。年龄增加和病程延长可能会限制内皮反应性作为 SLE 早期动脉粥样硬化的指标的潜力。
