系统性红斑狼疮患者动脉粥样硬化性心血管事件危险因素的演变：一项长期前瞻性研究。
Evolution of Risk Factors for Atherosclerotic Cardiovascular Events in Systemic Lupus Erythematosus: A Longterm Prospective Study.
机构信息
From the Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, Toronto, Ontario, Canada.
K. Tselios, MD, PhD, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network; J. Su, MB, BSc, Health Care and Outcomes Research, Toronto Western Hospital; O. Ace, MD, University of Toronto Lupus Clinic; M.B. Urowitz, MD, FRCPC, Centre for Prognosis Studies in Rheumatic Diseases, Toronto Lupus Clinic, University Health Network.
出版信息
J Rheumatol. 2017 Dec;44(12):1841-1849. doi: 10.3899/jrheum.161121. Epub 2017 Nov 1.
OBJECTIVE
We previously reported the effect of certain factors on cardiovascular disease (CVD) in 250 women with systemic lupus erythematosus (SLE) followed for 8 years. The aim of this study was to delineate their evolution after 15 years of followup.
METHODS
There were 210 women with SLE and 138 age-matched healthy women available for analysis after 15 years. Cardiovascular events (CVE) included angina pectoris, myocardial infarction (fatal and nonfatal), transient ischemic attack, and stroke (fatal and nonfatal). Analysis was performed with SAS 9.3 software; p < 0.05 was considered significant.
RESULTS
CVE occurred in 41/210 patients (19.5%) and 9/138 controls (6.5%), most of them in the second part (2008-2015) of the study (24/210, 11.4% vs 17/241, 7.1% in SLE group). Coronary artery disease was more common in patients (32/210, 15.2% vs 5/138, 3.6%, p = 0.0041). There was no significant difference for cerebrovascular disease (10/210, 4.8% vs 3/138, 2.2%, p = 0.213). SLE was the most prominent CVE predictor in the first 8 years (HR 2.8, 95% CI 1.3-6.3). Hypertension and diabetes were more frequent in patients who developed CVE during the second half of the study. Thirty-one deaths occurred in patients with SLE (10 because of CVD) and 6 in controls (none because of CVD).
CONCLUSION
The relative importance of atherosclerotic risk factors is significantly differentiated over time in SLE. Disease-related factors seem to dominate CV risk during the early stages while traditional factors, partially related to corticosteroid treatment, play a significant role later in the disease course.
目的
我们之前报道了 250 例系统性红斑狼疮（SLE）女性患者中某些因素对心血管疾病（CVD）的影响，这些患者随访 8 年。本研究的目的是描述她们在随访 15 年后的演变。
方法
15 年后，210 例 SLE 患者和 138 例年龄匹配的健康女性可供分析。心血管事件（CVE）包括心绞痛、心肌梗死（致命和非致命）、短暂性脑缺血发作和中风（致命和非致命）。分析采用 SAS 9.3 软件进行；p<0.05 被认为具有统计学意义。
结果
210 例患者中有 41 例（19.5%）和 138 例对照中有 9 例（6.5%）发生 CVE，其中大多数发生在研究的第二部分（2008-2015 年）（210 例中有 24 例，SLE 组为 11.4%，241 例中有 17 例，为 7.1%）。冠状动脉疾病在患者中更为常见（210 例中有 32 例，15.2%，138 例中有 5 例，3.6%，p=0.0041）。脑血管疾病无显著差异（210 例中有 10 例，4.8%，138 例中有 3 例，2.2%，p=0.213）。SLE 是前 8 年中最突出的 CVE 预测因素（HR 2.8，95%CI 1.3-6.3）。在研究的后半段发生 CVE 的患者中，高血压和糖尿病更为常见。210 例 SLE 患者中有 31 例死亡（10 例死于 CVD），对照组中有 6 例死亡（无 CVD 死亡）。
结论
SLE 中动脉粥样硬化危险因素的相对重要性随时间显著分化。疾病相关因素在疾病早期似乎主导 CV 风险，而传统因素（部分与皮质类固醇治疗有关）在疾病后期发挥重要作用。
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