Division of Rheumatology, Department of Radiology, and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Rheumatol. 2012 Dec;39(12):2286-93. doi: 10.3899/jrheum.120197. Epub 2012 Oct 1.
A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.
Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.
The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant.
Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.
红斑狼疮（SLE）患者发病率和死亡率的一个主要原因是冠状动脉粥样硬化加速。新技术（计算机断层血管造影）可以测量更易破裂的非钙化性冠状动脉斑块（NCP）。我们报告了 SLE 患者半定量 NCP 的研究结果。
我们对无心血管疾病史的 147 例 SLE 患者进行了 64 层冠状动脉多排螺旋 CT（MDCT）检查。MDCT 扫描由放射科医生使用专用软件进行定量评估。
147 例 SLE 患者中，86%为女性，70%为白人，29%为非裔美国人，3%为其他种族。平均年龄为 51 岁。在单因素分析中，与非钙化斑块相关的主要传统心血管危险因素为年龄（p = 0.007）、肥胖（p = 0.03；以体重指数衡量）、同型半胱氨酸（p = 0.05）和高血压（p = 0.04）。抗心磷脂抗体（p = 0.026；而非狼疮抗凝剂）和抗 dsDNA 抗体（p = 0.03）与较高的非钙化斑块相关。泼尼松和羟氯喹治疗无影响，但甲氨蝶呤（MTX）治疗与较高的非钙化斑块相关（p = 0.0001）。在最佳多变量模型中，年龄、当前 MTX 使用和抗 dsDNA 病史仍有显著意义。
我们的研究结果表明，SLE 的血清学标志物（抗 dsDNA）和传统心血管危险因素与 SLE 的半定量非钙化斑块有关。与 MTX 的相关性尚不清楚，但应在更大规模的研究中和多个中心进行重复验证。
