Department of Medicine, UKM Medical Center, Kuala Lumpur.
Lupus. 2011 Oct;20(12):1260-6. doi: 10.1177/0961203311411347. Epub 2011 Aug 15.
Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease.
To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN.
This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound.
A total of 82 patients with LN with a mean age of 33.9 ± 9.8( )years were recruited. More than half had hypertension (n = 55, 67.1%) and dyslipidemia (n = 43, 52.4%) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (r (s) = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide.
Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.
患有系统性红斑狼疮（SLE）的患者，尤其是狼疮肾炎（LN）患者，存在发生心血管（CV）疾病的风险。
评估 LN 患者免疫抑制剂的使用情况、传统 CV 危险因素与颈动脉内膜中层厚度（CIMT）之间的关系。
本研究为横断面研究，连续纳入在肾脏病/系统性红斑狼疮（SLE）科就诊的 LN 患者，评估其传统 CV 危险因素。从病历中获取其详细治疗信息。采用 B 型超声颈动脉内膜中层厚度（CIMT）测量仪测量 CIMT，CIMT 是亚临床动脉粥样硬化的良好标志物。
共纳入 82 例 LN 患者，平均年龄 33.9±9.8（ ）岁。超过一半的患者患有高血压（n=55，67.1%）和血脂异常（n=43，52.4%）等传统 CV 危险因素。更长的病史和更高的累积剂量的皮质类固醇与高血压相关，但静脉注射甲基强的松龙与较低的收缩压和舒张压以及较低的血清总胆固醇和甘油三酯水平相关（p均<0.05）。羟氯喹的使用与总胆固醇和血清低密度脂蛋白水平较低相关（p均<0.05）。环孢素 A（CyA）的使用与高血压相关（p<0.05），但接受较低累积剂量 CyA 的患者 CIMT 更厚（r（s）=-0.33，p=0.01），且在线性回归分析中 CyA 的使用仍然是 CIMT 的独立预测因素。CIMT 与皮质类固醇、羟氯喹、硫唑嘌呤、霉酚酸酯和环磷酰胺的累积剂量和持续时间均无相关性。
积极治疗严重 LN 和使用 CyA 作为皮质类固醇的节约剂可能对早发动脉粥样硬化具有保护作用。
