Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, France.
Département de Médecine Interne, Hôpital Cochin, Centre de Reference Maladies Auto-immunes et Systémiques Rares, APHP, Université de Paris, CRESS, INSERM, INRA, France.
Rheumatology (Oxford). 2021 Mar 2;60(3):1210-1215. doi: 10.1093/rheumatology/keaa434.
Identification of biological markers able to better stratify cardiovascular risks in SLE patients is needed. We aimed to determine whether serum cardiac troponin T (cTnT) levels measured with a highly sensitive assay [high sensitivity cTnT (HS-cTnT)] may predict cardiovascular events (CVEs) in SLE.
All SLE patients included between 2007 and 2010 in the randomized, double-blind, placebo-controlled, multicentre PLUS trial were screened. Patients with no past history of CVE at inclusion and a follow-up period of >20 months were analysed. HS-cTnT concentration was measured using the electrochemiluminescence method on serum collected at PLUS inclusion. The primary outcome was the incident CVE. Factors associated with the primary outcome were identified and multivariate analysis was performed.
Overall, 442 SLE patients (of the 573 included in the PLUS study) were analysed for the primary outcome with a median follow up of 110 (interquartile range: 99-120) months. Among them, 29 (6.6%) experienced at least one CVE that occurred at a median of 67 (interquartile range: 31-91) months after inclusion. Six out of 29 patients had more than one CVE. In the multivariate analysis, dyslipidaemia, age and HS-cTnT were associated with the occurrence of CVE. Kaplan-Meier analysis showed that a concentration of HS-cTnT > 4.27 ng/l at inclusion increased by 2.7 [hazard ratio 2.7 (95% CI: 1.3, 5.6), P =0.0083] the risk of CVE in SLE.
HS-cTnT measured in serum is the first identified biomarker independently associated with incident CVE in SLE patients.
需要鉴定能够更好地对系统性红斑狼疮（SLE）患者进行心血管风险分层的生物标志物。我们旨在确定使用高敏检测法（hs-cTnT）测量的血清心肌肌钙蛋白 T（cTnT）水平是否可以预测 SLE 患者的心血管事件（CVE）。
对 2007 年至 2010 年间纳入 PLUS 随机、双盲、安慰剂对照、多中心研究的所有 SLE 患者进行筛选。入选时无 CVE 既往史且随访时间>20 个月的患者被纳入分析。在 PLUS 入组时采集血清，采用电化学发光法检测 hs-cTnT 浓度。主要结局是首发 CVE。鉴定与主要结局相关的因素并进行多变量分析。
总体而言，对 PLUS 研究中纳入的 573 例患者中的 442 例（442/573，84.3%）进行了主要结局分析，中位随访时间为 110（四分位距：99-120）个月。其中，29 例（29/442，6.6%）至少发生了一次 CVE，发生在入组后中位时间 67（四分位距：31-91）个月。29 例患者中有 6 例发生了不止一次 CVE。多变量分析显示，血脂异常、年龄和 hs-cTnT 与 CVE 的发生相关。Kaplan-Meier 分析显示，入组时 hs-cTnT>4.27ng/L 使 SLE 患者的 CVE 风险增加 2.7 倍（危险比 2.7，95%CI：1.3，5.6，P=0.0083）。
血清 hs-cTnT 是第一个被鉴定出的与 SLE 患者首发 CVE 独立相关的生物标志物。
