From the University of Toronto Lupus Clinic and the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada; The University of Melbourne Departments of Medicine and Rheumatology, St. Vincent's Hospital, Melbourne, Victoria, Australia; Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.
J Rheumatol. 2013 Dec;40(12):2006-14. doi: 10.3899/jrheum.121273. Epub 2013 Oct 15.
To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE).
Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age.
Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5).
This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.
定量分析低密度脂蛋白胆固醇（LDL-C）、总胆固醇：高密度脂蛋白胆固醇比值（TC：HDL-C）、甘油三酯（TG）水平以及高密度脂蛋白胆固醇（HDL-C）作为系统性红斑狼疮（SLE）患者冠状动脉风险标志物的独立作用。
纳入了血脂检测指标在冠状动脉事件（或最近一次就诊）前采集的患者。为每位患者计算了各血脂变量的均值和时间调整均值（TAM）。采用时间依赖性比例风险回归模型，在调整年龄后，量化了冠状动脉事件（心肌梗死[MI]或心绞痛）的风险。
在 384 例患者中，平均（SD）随访 3.81（2.58）年后，发生了 21 例“首次”冠状动脉事件（6 例 MI，15 例心绞痛）。均值和 TAM LDL-C（HR 1.83，95%CI 1.19-2.81，p = 0.006）、TC：HDL 比值（HR 1.43，95%CI 1.02-2.00，p = 0.04）和 TG（HR 2.11，95%CI 1.32-3.39，p = 0.0019）在随后的就诊中预测了冠状动脉事件。在列联表分析中，TAM LDL-C 截断值为 2.0mmol/L 时，对冠状动脉事件的敏感性和阴性预测值分别为 85.7%（95%CI 63.7-97.0）和 93.9%（95%CI 83.1-98.7）。然而，此时的特异性仅为 12.7%（95%CI 9.4-16.5）。
本研究将 LDL-C、TC：HDL-C 比值和 TG 与 SLE 患者的冠状动脉风险联系起来，并量化了这种风险的程度。可能需要选择 SLE 特异性血脂风险评估水平，以优化阳性或阴性预测值。
