SLE 患者视网膜微血管损伤与亚临床动脉粥样硬化的关系。
Relationship between retinal microvascular impairment and subclinical atherosclerosis in SLE.
机构信息
Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy
Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy.
出版信息
Lupus Sci Med. 2023 Oct;10(2). doi: 10.1136/lupus-2023-000977.
OBJECTIVES
Patients with SLE have higher cardiovascular (CV) risk compared with healthy controls (HC) and are characterised by accelerated atherosclerosis; intima media thickness (IMT), marker of subclinical atherosclerosis, is higher in patients with SLE than in HCs. Retinal microvascular impairment detected through optical coherence tomography angiography (OCTA) was investigated as a marker of systemic vascular involvement in SLE.The aim of the study was to evaluate the relationship between retinal vascular impairment and IMT in SLE.
METHODS
Cross-sectional study recruiting patients with SLE and HCs. Data of the study population were collected. CV risk was evaluated through the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, Framingham and QRESEARCH risk estimator V.3 (QRISK3) scores. Both groups underwent OCTA and carotid ultrasound with IMT assessment.Statistical analysis was accomplished using Pearson/Spearman, t-test/Mann-Whitney or χ test. Variables statistically significant at univariate regression analysis were tested in an age-corrected and sex-corrected multivariate regression model.
RESULTS
43 patients with SLE and 34 HCs were recruited. Patients with SLE showed higher triglycerides (p=0.019), Triglycerides-Glucose (TyG) Index (p=0.035), ACC/AHA guidelines (p=0.001), Framingham Risk Scores (p=0.008) and a reduced superficial (p<0.001) and deep (p=0.005) whole retinal vessel density (VD) compared with HCs.In SLE univariate analysis, deep whole VD showed a negative correlation with IMT (p=0.027), age (p=0.001), systolic blood pressure (p=0.011), QRISK3 Score (p<0.001), Systemic Lupus International Collaborating Clinics Damage Index (p=0.006) and apolipoprotein B (p=0.021), while a positive correlation was found with female sex (p=0.029). Age-adjusted and sex-adjusted multivariate analysis confirmed QRISK3 Score (p=0.049) and IMT (p=0.039) to be independent risk factors for reduced retinal VD.
CONCLUSIONS
Patients with SLE showed lower retinal VD and higher CV risk indicators compared with HCs. Among patients with SLE, QRISK3 Score and IMT were found to be independent risk factors for retinal vascular impairment, suggesting a role of OCTA in evaluating preclinical CV involvement in SLE. Moreover, TyG Index could represent a biomarker of CV risk in patients with SLE compared with HCs.
目的
与健康对照组（HC）相比，SLE 患者的心血管（CV）风险更高，其特征是动脉粥样硬化加速；SLE 患者的内中膜厚度（IMT）高于 HC，IMT 是亚临床动脉粥样硬化的标志物。通过光学相干断层扫描血管造影（OCTA）检测到的视网膜微血管损伤被认为是 SLE 系统性血管受累的标志物。本研究旨在评估 SLE 患者视网膜血管损伤与 IMT 之间的关系。
方法
这项横断面研究招募了 SLE 患者和 HC。收集研究人群的数据。通过美国心脏病学会/美国心脏协会（ACC/AHA）指南、弗雷明汉和 QRESEARCH 风险估计器 V.3（QRISK3）评分评估 CV 风险。两组均进行 OCTA 和颈动脉超声检查，评估 IMT。使用 Pearson/Spearman、t 检验/Mann-Whitney 或 χ 检验进行统计分析。单变量回归分析中具有统计学意义的变量在年龄校正和性别校正的多变量回归模型中进行测试。
结果
共招募了 43 名 SLE 患者和 34 名 HC。与 HC 相比，SLE 患者的甘油三酯（p=0.019）、甘油三酯-血糖（TyG）指数（p=0.035）、ACC/AHA 指南（p=0.001）、弗雷明汉风险评分（p=0.008）和浅层（p<0.001）和深层（p=0.005）全视网膜血管密度（VD）降低。在 SLE 的单变量分析中，深层全 VD 与 IMT（p=0.027）、年龄（p=0.001）、收缩压（p=0.011）、QRISK3 评分（p<0.001）、系统性红斑狼疮国际合作临床损害指数（p=0.006）和载脂蛋白 B（p=0.021）呈负相关，而与女性性别（p=0.029）呈正相关。年龄校正和性别校正的多变量分析证实，QRISK3 评分（p=0.049）和 IMT（p=0.039）是视网膜血管损伤的独立危险因素。
结论
与 HC 相比，SLE 患者的视网膜 VD 较低，CV 风险指标较高。在 SLE 患者中，QRISK3 评分和 IMT 被发现是视网膜血管损伤的独立危险因素，这表明 OCTA 在评估 SLE 患者的临床前 CV 受累方面具有重要作用。此外，与 HC 相比，TyG 指数可能是 SLE 患者 CV 风险的生物标志物。
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