Svensson Christina, Eriksson Per, Zachrisson Helene, Sjöwall Christopher
Department of Clinical Physiology, University Hospital, Linköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Front Med (Lausanne). 2020 Oct 9;7:581336. doi: 10.3389/fmed.2020.581336. eCollection 2020.
Despite improved therapies and management, patients with systemic lupus erythematosus (SLE) still have increased risks of cerebrovascular and cardiovascular disease. High-frequency ultrasound (US) provides an opportunity to distinguish atherosclerosis from inflammation in the vessels. We hypothesized that an extended US protocol may add information regarding vascular affection in SLE. Sixty patients (52 women, 8 men; mean age 43.2 ± 11.3 years) with SLE characterized by either lupus nephritis (LN; = 20), antiphospholipid syndrome (APS; = 20), or skin and joint involvement ( = 20) as well as matched healthy controls ( = 60) were included. Intima-media thickness (IMT), assessment of vessel walls, and plaque occurrence were recorded using high-frequency US (GE Logic E9) in common carotid, internal carotid, brachiocephalic, subclavian, axillary, common femoral, and proximal superficial femoral arteries as well as in the aortic arch. For the entire SLE group, IMT was increased in the internal carotid artery (0.52 ± 0.17 vs. 0.45 ± 0.09 mm, = 0.004), the common femoral artery (0.57 ± 0.23 vs. 0.49 ± 0.11 mm, < 0.01), the subclavian artery (0.58 ± 0.19 vs. 0.53 ± 0.13 mm, = 0.02), and the aortic arch (1.21 ± 0.63 vs. 0.98 ± 0.25 mm, = 0.002) compared to controls. These differences were primarily observed in the APS and LN groups compared to controls. Vessels with increased IMT ≥0.9 mm had a smooth, medium echogenic appearance in areas free of atherosclerotic plaques. Atherosclerotic plaques were detected in 15/60 patients (25%) as compared to 2/60 of the controls (3%). Plaques were predominantly (67%) located in the carotid bifurcation. Multivariate analysis revealed influence of age on IMT in all vessel areas. Furthermore, in the common femoral artery, sagittal abdominal diameter, diastolic blood pressure, and cholesterol all showed association with increased IMT. In the internal carotid artery, male sex and presence of Raynaud phenomenon influenced IMT. Among SLE patients without presence of plaques, an extended US protocol revealed increased wall thickness with predominantly medium echogenic appearance highlighting possibly inflammation or early atherosclerosis. The appearance of vessel walls has not previously been studied in detail. An increased number of plaques were found in SLE compared to age- and sex-matched healthy controls. We found similar risk factors for increased IMT and occurrence of plaques, possibly indicating atherosclerotic mechanisms rather than inflammation.
尽管治疗方法和管理有所改善，但系统性红斑狼疮（SLE）患者发生脑血管和心血管疾病的风险仍然增加。高频超声（US）为区分血管中的动脉粥样硬化和炎症提供了机会。我们假设，扩展的超声检查方案可能会增加有关SLE血管病变的信息。纳入了60例SLE患者（52例女性，8例男性；平均年龄43.2±11.3岁），其特征为狼疮性肾炎（LN；n = 20）、抗磷脂综合征（APS；n = 20）或皮肤和关节受累（n = 20），以及匹配的健康对照（n = 60）。使用高频超声（GE Logic E9）记录颈总动脉、颈内动脉、头臂干、锁骨下动脉、腋动脉、股总动脉和股浅动脉近端以及主动脉弓的内膜中层厚度（IMT）、血管壁评估和斑块发生率。对于整个SLE组，与对照组相比，颈内动脉（0.52±0.17 vs. 0.45±0.09 mm，P = 0.004）、股总动脉（0.57±0.23 vs. 0.49±0.11 mm，P < 0.01）、锁骨下动脉（0.58±0.19 vs. 0.53±0.13 mm，P = 0.02）和主动脉弓（1.21±0.63 vs. 0.98±0.25 mm，P = 0.002）的IMT增加。与对照组相比，这些差异主要在APS和LN组中观察到。IMT≥0.9 mm增加的血管在无动脉粥样硬化斑块的区域具有光滑、中等回声的外观。15/60例患者（25%）检测到动脉粥样硬化斑块，而对照组为2/60例（3%）。斑块主要（67%）位于颈动脉分叉处。多变量分析显示年龄对所有血管区域的IMT有影响。此外，在股总动脉中，腹矢状径、舒张压和胆固醇均与IMT增加相关。在颈内动脉中，男性和雷诺现象的存在影响IMT。在无斑块的SLE患者中，扩展的超声检查方案显示血管壁厚度增加，主要为中等回声外观，突出了可能的炎症或早期动脉粥样硬化。血管壁的外观以前尚未进行详细研究。与年龄和性别匹配的健康对照相比，SLE患者中发现的斑块数量增加。我们发现IMT增加和斑块发生的危险因素相似，这可能表明是动脉粥样硬化机制而非炎症。
