Lupus nephritis as a factor of atherosclerosis risk in patients with systemic lupus erythematosus


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Aim. To investigate early atherosclerosis (AS) risk factors in patients with systemic lupus erythematosus (SLE) in respect to the presence of lupus nephritis (LN) and antiphospholipid (APL) antibodies. Material and methods. We analysed case histories of 137 SLE patients observed in E.M. Tareev clinic from 1970 to 2006. AS manifestations were studied by echocardiography, ultrasonic dopplerog-raphy of the peripheral vessels, x-ray methods. AS was considered early if it arose at the age under 55 years. Patients with chronic renal failure were not included in the study. Results. AS development was seen in 54 (45%) patients, early symptoms appeared at the age of 25-68 years (mean 54 ± 10 years). In 37 (31%) patients AS symptoms manifested at the age under 55 years. Significant factors of early AS risk were age, hyperlipidemia, arterial hypertension, menopause for women, APL antibodies circulation, stage IV chronic disease of the kidneys, hyperuricemia, higher blood creatinine, mean dose of prednisolone over 15 mg/day, frequent elevation of the level of C-reactive protein. A direct correlation between lupus nephritis or nephrotic syndrome (NS) and early AS was not found. In LN hyperlipidemia occurred more often (p=0.055), lipids level and NS were not related during its remission. LN patients developed AS more frequently, had lower complement concentration in the end of the study, were treated with prednisolone more intensively than patients free of renal disease (p<0.05). Conclusion. Early AS develops in more than one third of SLE patients. Main risk factors of early AS are conventional ones and APL antibodies, persistence of chronic inflammation, decreased glomerular filtration rate, prednisolone therapy. LN influence on the process of atherogenesis in SLE may be mediated and caused by high rate of other risk factors.

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Волчаночный нефрит как фактор риска атеросклероза у больных системной красной волчанкой. - Цель исследования. Исследовать факторы риска раннего развития атеросклероза (АС) у больных системной красной волчанкой (СКВ) в зависимости от наличия волчаночного нефрита (ВН) и антифосфолипидных антител (АФЛ). Материалы и методы. Изучены истории болезни и амбулаторные карты 137 больных СКВ, наблюдавшихся в клинике им. Е. М. Тареева с 1970 г. по май 2006 г. Для оценки проявлений АС использовали данные эхокардиографии, ультразвуковой допплерографии периферических сосудов, рентгенологических методов. Ранним развитием АС считали его появление в возрасте до 55 лет. Из исследования исключали больных с хронической почечной недостаточностью. Результаты. Развитие АС отмечено у 54 (45%) из всех пациентов, возраст появления признаков АС составлял от 25 до 68лет (средний 54 ± 10 лет). У 37 (31%) больных признаки АС выявлены в возрасте до 55 лет. Значимыми факторами риска развития раннего АС оказались возраст, гиперлипидемия, артериальная гипертензия, менопауза для женщин, циркуляция АФЛ, хроническая болезнь почек IV стадии, гиперуринемия, более высокий уровень креатинина крови в конце наблюдения, средняя суточная доза преднизолона не менее 15 мг и частота повышения уровня С-реактивного белка СРВ. Прямой связи между ВН или нефротическим синдромом (НС) и ранним АС не выявлено. Однако при ВН чаще выявляли гиперлипидемию (р = 0,055) в отсутствие связи между уровнем липидов и НС во время его ремиссии. У пациентов с ВН отмечалась большая частота АГ, более низкий уровень комплемента в конце наблюдения, проводилась более интенсивная терапия преднизолоном, чем у больных без поражения почек (р < 0,05). Заключение. Ранний АС развивается более чем у трети больных СКВ. Основными факторами риска преждевременного АС, помимо традиционных, являются АФЛ, персистирование хронического воспаления снижение скорости клубочковой фильтрации, терапия преднизолоном. Влияние ВН на процесс атерогенеза при СКВ, по-видимому, является опосредованным и обусловлено высокой частотой других факторов риска.
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