基于中国系统性红斑狼疮研究协作组（CSTAR）（XXVIII）的系统性红斑狼疮患者未来动脉粥样硬化性心血管疾病：不同抗磷脂抗体亚型的影响
Future atherosclerotic cardiovascular disease in systemic lupus erythematosus based on CSTAR (XXVIII): the effect of different antiphospholipid antibodies isotypes.
作者信息
Huang Can, Ding Yufang, Chen Zhen, Wu Lijun, Wei Wei, Zhao Cheng, Yang Min, Lin Shudian, Wang Qian, Tian Xinping, Zhao Jiuliang, Li Mengtao, Zeng Xiaofeng
机构信息
Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China.
Department of Rheumatology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
出版信息
BMC Med. 2025 Jan 6;23(1):8. doi: 10.1186/s12916-024-03843-9.
BACKGROUND
Patients with systemic lupus erythematosus (SLE) suffered from an increasing risk of cardiovascular diseases. In this multi-center prospective study, we aimed to determine the association between antiphospholipid antibodies (aPLs) and future atherosclerotic cardiovascular disease (ASCVD) in SLE.
METHODS
In total, 1573 SLE patients were recruited based on the Chinese SLE Treatment and Research group (CSTAR) registry. aPLs profile, including anticardiolipin antibodies (aCL) IgG/IgM, anti-β2 glycoprotein I antibodies (aβ2GPI) IgG/IgM, and lupus anticoagulant (LA), were measured in each center. Future ASCVD events were defined as new-onset myocardial infarction, stroke, artery revascularization, or cardiovascular death.
RESULTS
Among the 1573 SLE patients, 525 (33.4%) had positive aPLs. LA had the highest prevalence (324 [20.6%]), followed by aCL IgG (249 [15.8%]), aβ2GPI IgG (199 [12.7%]). 116 (7.37%) patients developed ASCVD during the mean follow-up of 4.51 ± 2.32 years and 92 patients were aPLs positive. In univariate Cox regression analysis, both aPLs (HR = 7.81, 95% CI 5.00-12.24, p < 0.001) and traditional risk factors of cardiovascular disease were associated with future ASCVD events. In multiple Cox regression analysis, aCL IgG (HR = 1.95, 95% CI 1.25-3.00, p = 0.003), aCL IgM (HR = 1.83, 95% CI 1.03-3.20, p = 0.039), and LA (HR = 5.13, 95% CI 3.23-8.20, p < 0.001) positivity remained associated with ASCVD; traditional risk factors for ASCVD, including smoking, gender, age and hypertension, also play an independent role in SLE patients. More importantly, Aspirin can reduce ASCVD risk in SLE patients with positive aPLs (HR = 0.57 95% CI, 0.25-0.93, P = 0.026).
CONCLUSIONS
SLE patients with positive aPLs, especially positive aCL IgG/IgM and LA, warrant more care and surveillance of future ASCVD events during follow-up. Aspirin may have a protective effect on future ASCVD.
背景
系统性红斑狼疮（SLE）患者患心血管疾病的风险日益增加。在这项多中心前瞻性研究中，我们旨在确定抗磷脂抗体（aPLs）与SLE患者未来动脉粥样硬化性心血管疾病（ASCVD）之间的关联。
方法
基于中国SLE治疗与研究组（CSTAR）登记系统，共招募了1573例SLE患者。在每个中心检测aPLs谱，包括抗心磷脂抗体（aCL）IgG/IgM、抗β2糖蛋白I抗体（aβ2GPI）IgG/IgM和狼疮抗凝物（LA）。未来的ASCVD事件定义为新发心肌梗死、中风、动脉血运重建或心血管死亡。
结果
在1573例SLE患者中，525例（33.4%）aPLs呈阳性。LA的患病率最高（324例[20.6%]），其次是aCL IgG（249例[15.8%]）、aβ2GPI IgG（199例[12.7%]）。在平均4.51±2.32年的随访期间，116例（7.37%）患者发生了ASCVD，其中92例患者aPLs呈阳性。在单因素Cox回归分析中，aPLs（HR = 7.81，95%CI 5.00 - 12.24，p < 0.001）和心血管疾病的传统危险因素均与未来的ASCVD事件相关。在多因素Cox回归分析中，aCL IgG（HR = 1.95，95%CI 1.25 - 3.00，p = 0.003）、aCL IgM（HR = 1.83, 95%CI 1.
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