Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
Atherosclerosis. 2020 Mar;297:55-63. doi: 10.1016/j.atherosclerosis.2020.01.028. Epub 2020 Jan 31.
Non-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS.
Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068.
The meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: -6.13%, -2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = - 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72-1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48-7.63; p = 0.003).
Overall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.
内皮功能障碍 (ED) 和外周动脉僵硬度 (AS) 等心血管 (CV) 疾病的非侵入性替代指标已在系统性红斑狼疮 (SLE) 患者中进行了评估。本研究旨在通过 ED 和 AS 系统地评估和荟萃分析 SLE 患者的心血管疾病 (CVD) 报告。
在 PubMed、Cochrane 图书馆、EMBASE、VHL、SciELO 和 Web of Science 数据库中系统地搜索了分析 SLE 与 ED（血流介导的扩张 [FMD]、硝酸甘油介导的扩张 [NMD] 和外周动脉张力计 [PAT]）和 AS（增强指数 [AIx]、脉搏波速度 [PWV]）关系的研究。纳入标准包括同行评议和英语。使用随机效应模型估计均值差异 (MD) 和 95%置信区间 (CI)。该研究在 PROSPERO 上进行了注册，编号为 CRD42019121068。
荟萃分析纳入了 49 项研究。纳入了 18 项研究的 FMD 数据，其中包括 943 名 SLE 受试者（平均年龄 38.71 [95%CI 36.21, 41.21] 岁）和 644 名未受影响的对照者（平均年龄 38.63 [95%CI 36.11, 41.15] 岁）。与未受影响的对照组相比，SLE 受试者的 FMD 降低了 4.3%（95%CI：-6.13%，-2.47%）：p<0.001）。然而，SLE 患者和对照组之间的 NMD 差异无统计学意义（MD=-2.68%；95%CI-6.00，0.62；p=0.11）。总体而言，SLE 患者与对照组相比，PWV 升高（MD=1.12 m/s；95%CI 0.72-1.52；p<0.001），但桡踝 PWV 无差异。与健康对照组相比，SLE 患者的 AIx 也升高（MD=4.55%；95%CI 1.48-7.63；p=0.003）。
总体而言，SLE 患者的 FMD 受损，这是 CV 事件的独立预测因子。SLE 患者的 AS 程度高于对照组。在制定预防策略和治疗方案时，应考虑 SLE 患者的 ED 和 AS。
