【摘要】：目的:系統(tǒng)性紅斑狼瘡(systemic lupus erythematosus,SLE)發(fā)生動脈粥樣硬化(atherosclerosis,AS)的風(fēng)險高于同年齡普通人群。本研究通過對在我院住院及門診確診的系統(tǒng)性紅斑狼瘡患者進(jìn)行資料收集,分析系統(tǒng)性紅斑狼瘡患者的臨床、實驗室數(shù)據(jù)及藥物使用情況,并應(yīng)用彩色超聲多普勒進(jìn)行頸動脈超聲檢查,以探討系統(tǒng)性紅斑狼瘡患者發(fā)生動脈粥樣硬化的臨床特點及危險因素,以期為早期干預(yù)動脈粥樣硬化病程進(jìn)展提供可靠依據(jù)。方法:本研究收集2014年4月至2015年2月在天津醫(yī)科大學(xué)總醫(yī)院風(fēng)濕免疫科住院及門診就診的系統(tǒng)性紅斑狼瘡患者89例,所有患者由專人進(jìn)行頸動脈彩色多普勒超聲檢查,并同時收集患者臨床及實驗室資料,臨床資料包括性別、年齡、病程、身高、體重、吸煙史、高血壓病史、糖尿病史、系統(tǒng)性紅斑狼瘡疾病活動度評分及糖皮質(zhì)激素、羥氯喹、環(huán)磷酰胺使用情況;實驗室資料包括:血總膽固醇、甘油三脂(triglyceride,TG)、高密度脂蛋白、低密度脂蛋白、血肌酐、血尿酸、血漿纖維蛋白原(fibrinogen,FIB)、血同型半胱氨酸(homocysteine,Hcy)、空腹血糖、血沉、C反應(yīng)蛋白(c-reactive protein,CRP)、24小時尿蛋白定量、補(bǔ)體C3、免疫球蛋白G、抗雙鏈DNA抗體定量、抗心磷脂抗體(anticardiolipin antibody,ACL)等相關(guān)血清指標(biāo)。依據(jù)2010年中國高血壓防治指南將雙側(cè)頸總動脈內(nèi)中膜厚度㩳0.9mm的患者納入SLE無AS組,任一側(cè)頸總動脈內(nèi)中膜厚度≥0.9mm納入SLE有AS組。對比不同分組間患者臨床、實驗室資料及藥物使用情況。將組間比較有統(tǒng)計學(xué)意義(P㩳0.05)的因素納入多因素Logistic回歸分析模型中。經(jīng)多因素Logistic回歸分析得到獨立危險因素。從而了解SLE患者合并AS的臨床特點及相關(guān)危險因素。結(jié)果:1.89例SLE中合并AS的17例,發(fā)生率為19.1%。SLE合并AS發(fā)生率隨年齡增加而上升,年齡20歲患者中AS發(fā)生率為0;20-30歲患者中AS發(fā)生率為7.7%;31-40歲患者中AS發(fā)生率為16.7%;41-50歲患者中AS發(fā)生率為21.4%;50歲患者中AS發(fā)生率為72.7%。2.SLE合并AS組年齡、BMI顯著高于無AS組,SLE合并AS組患者高血壓發(fā)生率顯著高于無AS組,提示傳統(tǒng)AS危險因素與SLE發(fā)生AS相關(guān)。SLE合并AS組TG高于無AS組,提示SLE合并AS組存在血脂代謝異常。SLE合并AS組Hcy、FIB高于無AS組。SLE合并AS組24小時尿蛋白定量高于無AS組,提示SLE合并AS組患者腎功能受損更嚴(yán)重。SLE合并AS組患者的血清CRP、ACL陽性率高于無AS組。SLE合并AS組患者的SLEDAI評分顯著高于無AS組患者,提示SLE合并AS組有更高的疾病活動度。SLE合并AS組中應(yīng)用羥氯喹治療的患者比例低于無AS組,提示應(yīng)用羥氯喹治療是SLE患者發(fā)生AS的保護(hù)性因素。3.年齡、SLEDAI評分是SLE合并AS的獨立危險因素。結(jié)論:1.SLE合并AS發(fā)生率隨年齡增加而上升。2.年齡,肥胖,高血壓,SLE疾病活動,腎臟損害,TG、FIB、Hcy、CRP異常升高,ACL陽性率高及未應(yīng)用羥氯喹治療與SLE發(fā)生AS相關(guān)。3.年齡、SLE疾病活動是SLE合并AS的獨立危險因素。
[Abstract]:Objective: the risk of atherosclerosis (atherosclerosis,AS) in systemic lupus erythematosus (systemic lupus erythematosus,SLE) is higher than that in the general population of the same age. In this study, the clinical, laboratory data and drug use of patients with systemic lupus erythematosus (SLE) diagnosed in our hospital and outpatient department were collected and analyzed. In order to explore the clinical characteristics and risk factors of atherosclerosis in patients with systemic lupus erythematosus (SLE), the carotid artery was examined by color Doppler ultrasound in order to provide reliable evidence for early intervention in the course of atherosclerosis. Methods: from April 2014 to February 2015, 89 patients with systemic lupus erythematosus (SLE) who were admitted to the Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, were collected. All patients were examined by carotid color Doppler ultrasound. Clinical and laboratory data were collected, including sex, age, course of disease, height, weight, smoking history, history of hypertension, history of diabetes, systemic lupus erythematosus disease activity score, glucocorticoid, hydroxychloroquine. Use of cyclophosphamide; Laboratory data included: total cholesterol, triglyceride (triglyceride,TG), high density lipoprotein, low density lipoprotein, serum creatinine, serum uric acid, plasma fibrinogen (fibrinogen,FIB), blood homocysteine (homocysteine,Hcy), fasting blood glucose, Erythrocyte sedimentation rate (ESR), C-reactive protein (c-reactive protein,CRP), 24 hour urine protein quantification, complement C3, immunoglobulin G, anti-double-stranded DNA antibody, anticardiolipin antibody (anticardiolipin antibody,ACL) and so on. According to the 2010 Chinese guidelines for the prevention and treatment of hypertension, the patients with bilateral common carotid artery intima media thickness (0.9mm) were included in the SLE without AS group, and any side common carotid artery IMT 鈮，

本文編號：2387909