系统性红斑狼疮女性的夜间血压模式与亚临床动脉粥样硬化
Nighttime Blood Pressure Patterns and Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus.
作者信息
Sabio José Mario, Martinez-Bordonado Josefina, Sánchez-Berná Isabel, Vargas-Hitos José Antonio, Mediavilla Juan Diego, Navarrete-Navarrete Nuria, Zamora-Pasadas Mónica, Ruíz Manuela Expósito, Jiménez-Alonso Juan
机构信息
From the Systemic Autoimmune Diseases Unit, Department of Internal Medicine, and Hypertension and Lipids Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; Department of Statistics, Investigación Biosanitaria de Andalucía Oriental Foundation, Granada, Spain.J.M. Sabio, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J. Martinez-Bordonado, MD, Research Fellow, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; I. Sánchez-Berná, MD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J.A. Vargas-Hitos, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; J.D. Mediavilla, MD, PhD, Hypertension and Lipids Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; N. Navarrete-Navarrete, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; M. Zamora-Pasadas, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves; M.E. Ruíz, MD, Department of Statistics, Investigación Biosanitaria de Andalucía Oriental Foundation; J. Jiménez-Alonso, MD, PhD, Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves.
出版信息
J Rheumatol. 2015 Dec;42(12):2310-7. doi: 10.3899/jrheum.150531.
OBJECTIVE
To compare 24-h ambulatory blood pressure (BP) monitoring (ABPM) values and patterns in women with systemic lupus erythematosus (SLE) with those of a matched control group and their relationship with the presence of subclinical atherosclerosis.
METHODS
ABPM was assessed in 70 women with SLE and in 65 sex- and age-matched controls without a history of clinic cardiovascular disease (CVD). Carotid-femoral pulse wave velocity (PWV), which is a marker of subclinical atherosclerosis and a predictor of future CVD, was measured. Multivariate logistic analysis was used to determine which explanatory variables were independently associated with the non-dipper pattern and the presence of nocturnal hypertension (HTN) in women with SLE.
RESULTS
No differences in PWV were found between patients and controls [median 7.3, interquartile range (IQR) 6.5-8.1 m/s vs median 7.1, IQR 6.5-7.8 m/s, p = 0.474]. The frequency of nondipper pattern (p = 0.025) and nocturnal HTN (p = 0.004) was significantly higher in women with SLE than in controls. White-coat and masked HTN were present in 10% and 11% of patients and in 20% and 8% of controls, respectively (p > 0.05 in all cases). The concordance between office and ambulatory HTN in the SLE and control groups was modest (κ = 0.325 and κ = 0.451, respectively). PWV and chronic kidney disease, and PWV and the Systemic Lupus Erythematosus Disease Activity Index were found to be independently associated with nocturnal HTN and nondipper pattern, respectively.
CONCLUSION
Women with SLE were more likely to have an altered nighttime BP pattern than controls. In women with SLE, nondipper pattern and nocturnal HTN were independently associated with increased subclinical atherosclerosis measured by PWV.
目的
比较系统性红斑狼疮（SLE）女性与匹配对照组的24小时动态血压（BP）监测值及模式，并探讨其与亚临床动脉粥样硬化的关系。
方法
对70例SLE女性患者和65例无临床心血管疾病（CVD）病史的性别及年龄匹配的对照者进行动态血压监测。测量颈动脉-股动脉脉搏波速度（PWV），其为亚临床动脉粥样硬化的标志物及未来CVD的预测指标。采用多因素逻辑分析确定哪些解释变量与SLE女性的非勺型模式及夜间高血压（HTN）独立相关。
结果
患者与对照组的PWV无差异[中位数7.3，四分位数间距（IQR）6.5 - 8.1 m/s vs中位数7.1，IQR 6.5 - 7.8 m/s，p = 0.474]。SLE女性的非勺型模式频率（p = 0.025）和夜间HTN频率（p = 0.004）显著高于对照组。白大衣高血压和隐匿性高血压分别见于10%和11%的患者以及20%和8%的对照者（所有情况p > 0.05）。SLE组和对照组诊室高血压与动态高血压之间的一致性一般（κ分别为0.325和0.451）。发现PWV与慢性肾脏病，以及PWV与系统性红斑狼疮疾病活动指数分别独立与夜间HTN和非勺型模式相关。
结论
SLE女性比对照组更易出现夜间血压模式改变。在SLE女性中，非勺型模式和夜间HTN与通过PWV测量的亚临床动脉粥样硬化增加独立相关。
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