Nuntasri Sirin, Charuvanij Sirirat, Lomjansook Kraisoon, Saengpanit Puthita, Chotipanang Kwanjai, Sukharomana Maynart
Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Lipids Health Dis. 2024 Dec 18;23(1):406. doi: 10.1186/s12944-024-02395-4.
Childhood-onset systemic lupus erythematosus (cSLE) is associated with significant morbidity and mortality. Dyslipidemia and metabolic syndrome are recognized risk factors for premature atherosclerosis. This study aimed to determine the prevalence of dyslipidemia and metabolic syndrome, and to explore the relationships between lipid profiles, anthropometry, and disease status in cSLE.
This cross-sectional study was conducted at a university-based tertiary referral center from April 2023-March 2024. Patients aged 10-19 years with cSLE diagnosed before 18 years and at least 1 year follow-up were enrolled, excluding those with other autoimmune disorders, chronic kidney disease, infections, receiving lipid lowering drugs prior, and pregnancy. Demographic data, metabolic laboratory tests, disease status, dietary intake, anthropometry, and body composition via bioelectric impedance analysis were evaluated. The prevalence of dyslipidemia and metabolic syndrome were documented. Variables were compared between patients with and without dyslipidemia. Correlations between lipid profiles, metabolic laboratory variables, and SLE disease-related variables were explored.
A total of 132 cSLE patients (94.7% female, mean age 11.6 ± 2.6 years) were included. Dyslipidemia was present in 48.5%, hypertriglyceridemia being the most common (28.8%); metabolic syndrome and hyperuricemia were present in 3.8% and 20.5%, respectively. Patients with dyslipidemia were significantly younger at cSLE diagnosis, had higher percentage of hypertension and active features of organ involvement, lower percentage of Lupus Low Disease Activity State, more use of mycophenolate mofetil and antihypertensive medications, higher uric acid level, higher waist circumference, body mass index, body mass index z-score, and fat mass (P < 0.05). Triglycerides, low-density lipoprotein cholesterol, and total cholesterol correlated positively with urine protein-to-creatinine ratio (r = 0.472, 0.469, and 0.591, respectively; P < 0.001) and negatively with serum albumin (r = -0.372, -0.506, and - 0.528, respectively; P < 0.001). Total cholesterol and low-density lipoprotein cholesterol correlated positively with cumulative prednisolone equivalent dose (rho = 0.350 and rho = 0.351, respectively, P < 0.001).
Nearly half of cSLE patients had dyslipidemia, especially those with younger age at diagnosis, higher body mass index, proteinuria, and suboptimal-controlled disease. Metabolic syndrome and hyperuricemia were present. Lipid profile assessment in early adolescents is recommended to identify metabolic comorbidities in cSLE.
儿童期起病的系统性红斑狼疮（cSLE）与显著的发病率和死亡率相关。血脂异常和代谢综合征是公认的早发性动脉粥样硬化的危险因素。本研究旨在确定cSLE患者血脂异常和代谢综合征的患病率，并探讨血脂谱、人体测量指标与疾病状态之间的关系。
本横断面研究于2023年4月至2024年3月在一家大学附属三级转诊中心进行。纳入年龄在10 - 19岁、18岁前诊断为cSLE且至少随访1年的患者，排除患有其他自身免疫性疾病、慢性肾脏病、感染、既往接受过降脂药物治疗以及妊娠的患者。评估人口统计学数据、代谢实验室检查、疾病状态、饮食摄入、人体测量指标以及通过生物电阻抗分析得出的身体成分。记录血脂异常和代谢综合征的患病率。比较血脂异常患者和无血脂异常患者的变量。探讨血脂谱、代谢实验室变量与SLE疾病相关变量之间的相关性。
共纳入132例cSLE患者（94.7%为女性，平均年龄11.6±2.6岁）。血脂异常的患病率为48.5%，其中高甘油三酯血症最为常见（28.8%）；代谢综合征和高尿酸血症的患病率分别为3.8%和20.5%。血脂异常患者在cSLE诊断时年龄显著更小，高血压和器官受累活动特征的比例更高，狼疮低疾病活动状态的比例更低，更多使用霉酚酸酯和抗高血压药物，尿酸水平更高，腰围、体重指数、体重指数z评分和脂肪量更高（P < 0.05）。甘油三酯、低密度脂蛋白胆固醇和总胆固醇与尿蛋白/肌酐比值呈正相关（r分别为0.472、0.469和0.591；P < 0.001），与血清白蛋白呈负相关（r分别为 - 0.372、 - 0.506和 - 0.528；P < 0.001）。总胆固醇和低密度脂蛋白胆固醇与累积泼尼松等效剂量呈正相关（rho分别为0.350和0.351，P < 0.001）。
近一半的cSLE患者存在血脂异常，尤其是那些诊断时年龄较小、体重指数较高、有蛋白尿且疾病控制不佳的患者。存在代谢综合征和高尿酸血症。建议对青少年早期进行血脂谱评估，以识别cSLE患者的代谢合并症。
