Rahman P, Gladman D D, Urowitz M B, Yuen K, Hallett D, Bruce I N
University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, The Toronto Hospital, Ontario, Canada.
J Rheumatol. 1999 Feb;26(2):325-30.
To examine the relationship between antimalarial therapy and total cholesterol in patients with systemic lupus erythematosus (SLE) with or without steroid therapy.
Retrospective study for the University of Toronto Lupus Clinic database between 1976 and 1997. The effects of antimalarials on random total cholesterol levels were assessed in the following situations: patients not receiving steroids (part I) that either initiated or discontinued antimalarials; patients receiving steroids (part II) that were either on a stable dose or initiating antimalarials; and patients initiating steroids with or without antimalarials (part III). Paired t test, Fisher's exact test, and 2 way analysis of variance were used when appropriate.
Initiation of antimalarials reduced the baseline total cholesterol by 4.1 % at 3 months in 53 patients (p = 0.020) and by 0.6% at 6 months in 30 patients (p = NS), while the cessation of antimalarials increased the total cholesterol by 3.6% at 3 months in 38 patients (p = NS) and 5.4% at 6 months in 22 patients (p = NS). In 181 patients taking steroids and antimalarials, the mean total cholesterol was 11% less than for 201 patients receiving a comparable dose of steroids alone (p = 0.0023). Initiation of antimalarials on a stable dose of steroids reduced the total cholesterol by 11.3% at 3 months in 29 patients (p = 0.0002) and 9.4% at 6 months in 20 patients (p = 0.004). For patients initiating steroids, the percentage increase in cholesterol was lower in those taking antimalarials compared to patients without antimalarial therapy (p = 0.0149).
Antimalarials lower total cholesterol in patients receiving steroids and may minimize steroid induced hypercholesterolemia.
研究接受或未接受类固醇治疗的系统性红斑狼疮（SLE）患者抗疟治疗与总胆固醇之间的关系。
对1976年至1997年多伦多大学狼疮诊所数据库进行回顾性研究。在以下情况下评估抗疟药对随机总胆固醇水平的影响：未接受类固醇治疗的患者（第一部分），即开始或停用抗疟药的患者；接受类固醇治疗的患者（第二部分），即处于稳定剂量或开始使用抗疟药的患者；以及开始使用类固醇且使用或未使用抗疟药的患者（第三部分）。在适当情况下使用配对t检验、Fisher精确检验和双向方差分析。
53例患者在3个月时开始使用抗疟药使基线总胆固醇降低了4.1%（p = 0.020），30例患者在6个月时降低了0.6%（p = 无显著性差异），而停用抗疟药使38例患者在3个月时总胆固醇升高了3.6%（p = 无显著性差异），22例患者在6个月时升高了5.4%（p = 无显著性差异）。在181例服用类固醇和抗疟药的患者中，平均总胆固醇比201例仅接受同等剂量类固醇治疗的患者低11%（p = 0.0023）。在稳定剂量的类固醇基础上开始使用抗疟药使29例患者在3个月时总胆固醇降低了11.3%（p = 0.0002），20例患者在6个月时降低了9.4%（p = 0.004）。对于开始使用类固醇的患者，与未接受抗疟治疗的患者相比，服用抗疟药的患者胆固醇升高百分比更低（p = 0.0149）。
抗疟药可降低接受类固醇治疗患者的总胆固醇，并可能使类固醇诱导的高胆固醇血症降至最低。
