Mak Anselm, Chan Jerry Kok Yen
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.
Nat Rev Rheumatol. 2022 May;18(5):286-300. doi: 10.1038/s41584-022-00770-y. Epub 2022 Apr 7.
The observations that traditional cardiovascular disease (CVD) risk factors fail to fully account for the excessive cardiovascular mortality in patients with systemic lupus erythematosus (SLE) compared with the general population have prompted in-depth investigations of non-traditional, SLE-related risk factors that contribute to cardiovascular complications in patients with SLE. Of the various perturbations of vascular physiology, endothelial dysfunction, which is believed to occur in the earliest step of atherosclerosis, has been extensively investigated for its contribution to CVD risk in SLE. Endothelial progenitor cells (EPCs), which play a crucial part in vascular repair, neovascularization and maintenance of endothelial function, are quantitatively and functionally reduced in patients with SLE. Yet, the lack of a unified definition of EPCs, standardization of the quantity and functional assessment of EPCs as well as endothelial function measurement pose challenges to the translation of endothelial function measurements and EPC levels into prognostic markers for CVD in patients with SLE. This Review discusses factors that contribute to CVD in SLE, with particular focus on how endothelial function and EPCs are evaluated currently, and how EPCs are quantitatively and functionally altered in patients with SLE. Potential strategies for the use of endothelial function measurements and EPC quantification as prognostic markers of CVD in patients with SLE, and the limitations of their prognostication potential, are also discussed.
与普通人群相比，传统心血管疾病（CVD）风险因素无法完全解释系统性红斑狼疮（SLE）患者心血管死亡率过高的现象，这促使人们对导致SLE患者心血管并发症的非传统、与SLE相关的风险因素进行深入研究。在血管生理的各种紊乱中，内皮功能障碍被认为发生在动脉粥样硬化的最早阶段，因其对SLE患者CVD风险的影响已得到广泛研究。内皮祖细胞（EPCs）在血管修复、新生血管形成和内皮功能维持中起关键作用，在SLE患者中其数量和功能均有所降低。然而，EPCs缺乏统一的定义、EPCs数量和功能评估以及内皮功能测量的标准化，给将内皮功能测量和EPC水平转化为SLE患者CVD的预后标志物带来了挑战。本综述讨论了导致SLE患者CVD的因素，特别关注目前如何评估内皮功能和EPCs，以及SLE患者中EPCs在数量和功能上是如何改变的。还讨论了将内皮功能测量和EPC量化用作SLE患者CVD预后标志物的潜在策略及其预后潜力的局限性。
