Wigren M, Nilsson J, Kaplan M J
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
J Intern Med. 2015 Nov;278(5):494-506. doi: 10.1111/joim.12357.
Systemic lupus erythematosus (SLE) is an autoimmune disorder that primarily affects young women and is characterized by inflammation in several organs including kidneys, skin, joints, blood and nervous system. Abnormal immune cellular and humoral responses play important roles in the development of the disease process. Impaired clearance of apoptotic material is a key factor contributing to the activation of self-reactive immune cells. The incidence of atherosclerotic cardiovascular disease (CVD) is increased up to 50-fold in patients with SLE compared to age- and gender-matched controls, and this can only partly be explained by traditional risk factors for CVD. Currently, there is no effective treatment to prevent CVD complications in SLE. Traditional preventive CVD therapies have not been found to significantly lower the incidence of CVD in SLE; therefore, there is a need for novel treatment strategies and increased understanding of the mechanisms involved in the pathogenesis of CVD complications in SLE. The pathogenic immune responses in SLE and development of atherosclerotic plaques share some characteristics, such as impaired efferocytosis and skewed T-cell activation, suggesting the possibility of identifying novel targets for intervention. As novel immune-based therapies for CVD are being developed, it is possible that some of these may be effective for the prevention of CVD and for immunomodulation in SLE. However, further understanding of the mechanisms leading to an increased prevalence of cardiovascular events in SLE is critical for the development of such therapies.
系统性红斑狼疮（SLE）是一种自身免疫性疾病，主要影响年轻女性，其特征是包括肾脏、皮肤、关节、血液和神经系统在内的多个器官发生炎症。异常的免疫细胞和体液反应在疾病进程的发展中起重要作用。凋亡物质清除受损是导致自身反应性免疫细胞激活的关键因素。与年龄和性别匹配的对照组相比，SLE患者的动脉粥样硬化性心血管疾病（CVD）发病率增加了50倍，而这只能部分地用CVD的传统危险因素来解释。目前，尚无有效的治疗方法来预防SLE中的CVD并发症。传统的预防性CVD治疗方法尚未发现能显著降低SLE中CVD的发病率；因此，需要新的治疗策略，并加深对SLE中CVD并发症发病机制的理解。SLE中的致病性免疫反应和动脉粥样硬化斑块的形成具有一些共同特征，如吞噬作用受损和T细胞活化失衡，这表明有可能识别出新的干预靶点。随着新型基于免疫的CVD治疗方法的开发，其中一些方法可能对预防CVD和SLE中的免疫调节有效。然而，进一步了解导致SLE中心血管事件患病率增加的机制对于开发此类治疗方法至关重要。
