Szabó Melinda Zsuzsanna, Szodoray Peter, Kiss Emese
Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
Institute of Immunology, Rikshospitalet, Oslo University, Oslo, Norway.
Immunol Res. 2017 Apr;65(2):543-550. doi: 10.1007/s12026-016-8892-9.
Cardiovascular disease is one of the major causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Accelerated atherosclerosis is related to traditional (age, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, and positive family history) and non-traditional, disease-related factors. Traditional risk factors are still more prominent in patients with lupus, as both hypertension and hypercholesterinemia were independently associated with premature atherosclerosis in several SLE cohorts. In this work, the authors summarize the epidemiology of dyslipidemia in lupus patients and review the latest results in the pathogenesis of lipid abnormalities. The prevalence of dyslipidemia, with elevations in total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (TG), and apolipoprotein B (ApoB), and a reduction in low-density lipoprotein (LDL) levels are about 30% at the diagnosis of SLE rising to 60% after 3 years. Multiple pathogenetic mechanism is included, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can suppress HDL and increase TG, auto-antibodies can cause the injury of the endothelium, lipoprotein lipase (LPL) activity can be reduced by circulating inflammatory mediators and antibodies, and increased oxidative stress may trigger a wide range of pro-atherogenic lipid modifications. As a major risk factor, dyslipidemia should be treated aggressively to minimize the risk of atherosclerosis and cardiovascular events. Randomized controlled trials with statins are controversial in the detention of atherosclerosis progression, but can be favorable by inhibiting immune activation that is the arterial wall and by decreasing lupus activity.
心血管疾病是系统性红斑狼疮(SLE)患者发病和死亡的主要原因之一。动脉粥样硬化加速与传统因素(年龄、高血压、糖尿病、血脂异常、肥胖、吸烟和家族史阳性)以及非传统的疾病相关因素有关。传统危险因素在狼疮患者中仍然更为突出,因为在多个SLE队列中,高血压和高胆固醇血症均与过早发生动脉粥样硬化独立相关。在这项研究中,作者总结了狼疮患者血脂异常的流行病学,并回顾了脂质异常发病机制的最新研究结果。血脂异常的患病率,即总胆固醇(TC)、低密度脂蛋白(LDL)、甘油三酯(TG)和载脂蛋白B(ApoB)升高,以及高密度脂蛋白(HDL)水平降低,在SLE诊断时约为30%,3年后升至60%。其发病机制包括多种,C反应蛋白(CRP)和红细胞沉降率(ESR)可抑制HDL并升高TG,自身抗体可导致内皮损伤,循环炎症介质和抗体可降低脂蛋白脂肪酶(LPL)活性,氧化应激增加可能引发一系列促动脉粥样硬化的脂质修饰。作为主要危险因素,应积极治疗血脂异常,以降低动脉粥样硬化和心血管事件的风险。他汀类药物的随机对照试验在延缓动脉粥样硬化进展方面存在争议,但通过抑制动脉壁的免疫激活和降低狼疮活动可能有益。