Hearth-Holmes M, Baethge B A, Broadwell L, Wolf R E
Section of Rheumatology, Louisiana State University Medical Center, Shreveport, USA.
J Rheumatol. 1995 Mar;22(3):450-4.
To evaluate dietary therapy in the treatment of hyperlipidemia in patients with systemic lupus erythematosus (SLE).
Using the National Cholesterol Education Program (NCEP) guidelines, we screened 89 patients with SLE for hyperlipidemia. Step 1 dietary therapy was instituted in 28 patients as recommended by the NCEP. Twenty-six patients failed Step 1 intervention and received Step 2 dietary therapy for an additional 3 months. Twenty-nine control patients with SLE were tested for hyperlipidemia.
The 89 patients with SLE (94% women, 77% black) had a mean age of 37.2 years. Fasting values were total cholesterol (TC) 6.22 +/- 0.16 mmol/l (240.9 +/- 6.0 mg/dl), low density lipoprotein cholesterol (LDL-C) 4.08 +/- 0.14 mmol/l, (157.6 +/- 5.3 mg/dl), high density lipoprotein (HDL-C) 1.37 +/- 0.08 mmol/l (53.0 +/- 3.1 mg/dl), and triglyceride (TG) 1.71 +/- 0.12 mmol/l, (151.9 +/- 10.6 mg/dl). The mean dose of prednisone was 14.2 +/- 1.6 mg/day. Prednisone dose correlated with levels of TC (p < 0.01) by linear regression. The 28 patients receiving Step 1 dietary intervention had TC 6.11 +/- 0.19 mmol/l (236.4 +/- 7.3 mg/dl), LDL-C 4.05 +/- 0.19 mmol/l (156.6 +/- 7.5 mg/dl), HDL-C 1.31 +/- 0.08 mmol/l (50.7 +/- 3.0 mg/dl), and TG 1.64 +/- 0.12 mmol/l (145.4 +/- 10.3 mg/dl). The 26 patients receiving Step 2 dietary intervention had TC 5.84 +/- 0.17 mmol/l (226.0 +/- 6.6 mg/dl), LDL-C 3.83 +/- 0.19 mmol/l (148.0 +/- 7.2 mg/dl), HDL-C 1.25 +/- 0.08 mmol/l (48.5 +/- 3.2 mg/dl), and TG 1.66 +/- 0.15 mmol/l (147.1 +/- 13.4 mg/dl). The mean prednisone dose was 14.8 +/- 3.0 mg/day for both study groups. There was no significance between prednisone doses in all groups studied (p = 0.08). After 6 months of dietary therapy, there was a significant decrease in only the TC (p = 0.158).
TC correlated directly with the prednisone dose. Six months of dietary intervention was required to significantly decrease the TC. Further management of hyperlipidemia will probably require drug intervention.
评估饮食疗法对系统性红斑狼疮（SLE）患者高脂血症的治疗效果。
依据美国国家胆固醇教育计划（NCEP）指南，我们对89例SLE患者进行了高脂血症筛查。按照NCEP的建议，28例患者接受了第一步饮食疗法。26例患者在第一步干预中失败，并接受了为期3个月的第二步饮食疗法。另外对29例SLE对照患者进行了高脂血症检测。
89例SLE患者（94%为女性，77%为黑人）的平均年龄为37.2岁。空腹血脂水平为：总胆固醇（TC）6.22±0.16 mmol/L（240.9±6.0 mg/dl），低密度脂蛋白胆固醇（LDL-C）4.08±0.14 mmol/L（157.6±5.3 mg/dl），高密度脂蛋白（HDL-C）1.37±0.08 mmol/L（53.0±3.1 mg/dl），甘油三酯（TG）1.71±0.12 mmol/L（151.9±10.6 mg/dl）。泼尼松的平均剂量为14.2±1.6 mg/天。通过线性回归分析，泼尼松剂量与TC水平相关（p<0.01）。接受第一步饮食干预的28例患者的TC为6.11±0.19 mmol/L（236.4±7.3 mg/dl），LDL-C为4.05±0.19 mmol/L（156.6±7.5 mg/dl），HDL-C为1.31±0.08 mmol/L（50.7±3.0 mg/dl），TG为1.64±0.12 mmol/L（145.4±10.3 mg/dl）。接受第二步饮食干预的26例患者的TC为5.84±0.17 mmol/L（226.0±6.6 mg/dl），LDL-C为3.83±0.19 mmol/L（148.0±7.2 mg/dl），HDL-C为1.25±0.08 mmol/L（48.5±3.2 mg/dl），TG为1.66±0.15 mmol/L（147.1±13.4 mg/dl）。两个研究组的泼尼松平均剂量均为14.8±3.0 mg/天。在所有研究组中，泼尼松剂量之间无显著差异（p = 0.08）。经过6个月的饮食治疗，仅TC有显著下降（p = 0.158）。
TC与泼尼松剂量直接相关。需要6个月的饮食干预才能使TC显著下降。高脂血症的进一步管理可能需要药物干预。
