| Objective: Systemic lupus erythematosus(SLE)is a diffuse connective tissue disease caused by self-immune system which mostly happened in young women.Researchs have shown that compared with healthy people,patients have higher incidence of cardiovascular disease who suffer from self-immune system illness,especially SLE and rheumatoid arthritis(RA).In addition,the majority of SLE patients with cardiovascular disease have insidious onset.Cardiovascular events have now become one of the important reasons for the increasing mortality of SLE.In our study,we use ultrasound to detect the carotid intima-media thickness(CIMT),resistance index(RI),end-diastolic velocity(EDV)and peak systolic velocity(PSV)of SLE patients,and try to address the associations between carotid atherosclerosis and the serum of angiogenic factors,such as VEGF,VEGF121,VEGF165 and PIGF.According to the indexes above,we try to explore the risk factors of SLE with carotid atherosclerosis,and then,provide evidence for the prevention of cardiovascular disease and improve the prognosis and outcome of lupus.Methods:1 The text group included sixty premenopausal female patients from the Department of Immunology and Rheumatology of the Second Hospital of Hebei Medical University who fulfilled ≥4 of the American College of Rheumatology(ACR)2009 revised criteria for the classification of SLE.According to the systemic lupus erythematosus disease activity index(SLEDAI),the test group were divided into mild activity group(5-9 scores),moderate activity group(10-14 scores)and severe activity group(≥15 scores).According to the course of the systemic lupus erythematosus disease,the test group were divided into early-phase group(duration of disease was <2 years),mid-phase group(duration of disease was between 2 and 4 years)and late-phase group(duration of disease was >4 years).According to the results of CIMT,the test group were divided into no plaque group(CIMT<0.8mm and no plaque formation)、plaque thickening group(0.8mm≤CIMT<1mm and no plaque formation),plaque formation group(CIMT≥1mm and have qlaque formation).The healthy control group included twenty premenopausal female who underwent the medical examination in the Second Hospital of Hebei Medical University.2 The carotid artery intima-media thickness were measured by high-frequency two-dimensional ultrasound,and recorded the resistance index,end-diastolic velocity and peak systolic velocity.3 ELISA method were used to detect the expression of serum VEGF,VEGF121,VEGF165 and PIGF.Compare the differences and analyze the associations.4 General conditions,clinical manifestations,laboratory indexes as well as the results of auxiliary examinations of test group were recorded and analyzed.5 SPSS 13.0 statistical software was used for data processing and analysis.Results: 1 General Information 1.1 There were no differences in the age and body mass index beween text group and healty control group(P>0.05).1.2 There were no differences in the body mass index among mild,morderate and severe activity groups(P>0.05).The differences existed in the age among the three groups respectively(P<0.05).1.3 There were no differences in the age and body mass index among early-phase,mid-phase and late-phase groups(P>0.05).1.4 There were no differences in the age and body mass index among no plaque,plaque thickening and plaque formation groups(P>0.05).2 Serum of angiogenic factor 2.1 Serum level of VEGF,VEGF121,VEGF165 2.1.1 The serum level of VEGF,VEGF121,VEGF165 was much higher in test group compared with healthy control group(P<0.05).2.1.2 Compared with healthy control group,the serum level of VEGF,VEGF121,VEGF165 were much higher in each activity group(P<0.05).Thereinto,the serum level of VEGF and VEGF121 of severe activity groups was much higher than morderate activity groups(P<0.05).Compare with severe activity group,the mild and morderate activity groups had higher level of serum VEGF165(P<0.05).2.1.3Compared with healthy control group,the serum level of VEGF,VEGF121,VEGF165 were much higher in each course group(P<0.05).Thereinto,the serum level of VEGF165 of late-phase groups was lower than the early-phase groups(P<0.05).2.1.4Compared with healthy control group,the serum level of VEGF,VEGF121,VEGF165 were much higher in each plaque group(P<0.05).Thereinto,the serum level of VEGF of plaque thickning groups was much higher than the no plaque group(P<0.05).2.1.5 There was a positive correlation between serum VEGF,VEGF121,VEGF165 level and SLEDAI in test group(r=0.312 P=0.015,r=0.281 P=0.030,r=0.341 P=0.008)2.2 Serum level of PIGF 2.2.1 The serum level of PIGF was much higher in test group compared with healthy control group(P<0.05).2.2.2 Compared with healthy control group,the serum level of PIGF was much higher in each activity group(P<0.05).Thereinto,compared with mild activity group,the morderate and severe activity groups had much higer level of PIGF(P<0.05).2.2.3 Compared with healthy control group,the serum level of PIGF was much higher in each course group(P<0.05).Thereinto,compare with late-phase group,the mid-phase group had much lower level of PIGF(P<0.05).2.2.4 Compared with healthy control group,the serum level of PIGF was much higher in each plaque group(P<0.05).2.2.5 There was no correlation between serum PIGF level and SLEDAI in test group.(r=0.240 P=0.065)3 Results of ultrasound 3.1 CIMT 3.1.1The CIMT was much thicker in test group than healthy control group(P<0.05).3.1.2Compared with healthy control group,CIMT was much thicker in each activity group(P<0.05).Thereinto,compared with severe activity group,CIMT in mild and morderate activity groups were much thinner(P<0.05).3.1.3Compared with healthy control group,CIMT was much thicker in each course group(P<0.05).3.1.4There was a positive correlation between CIMT and SLEDAI in test group(r=0.297,P=0.021).3.2 PSV 3.2.1 The PSV was much slower in test group than healthy control group(P<0.05).3.2.2 Compared with healthy control group,the PSV was much slower in each activity group(P<0.05).Thereinto,the PSV in severe group is much slower than that in moderate group,the PSV in severe group is much slower than that in mild group,the PSV in moderate group is much slower than that in mild group(P<0.05).3.2.3Compared with healthy control group,the PSV was much slower in each course group(P<0.05).3.2.4 Compared with healthy control group,the PSV was much slower in each plaque group(P<0.05).3.2.5 There was a negtive correlation between PSV and SLEDAI in test group(r=﹣0.511,P=0.000).3.3.1 The EDV was much slower in test group than healthy control group(P<0.05).3.3.2 Compared with healthy control group,the EDV was much slower in each activity group(P<0.05).Thereinto,the EDV in severe group is much slower than that in mild group(P<0.05).3.3.3 Compared with healthy control group,the EDV was much slower in each course group(P<0.05)3.3.4 Compared with healthy control group,the EDV was much slower in each plaque group(P<0.05).3.3.5 There was a negtive correlation between EDV and SLEDAI in test group(r=﹣0.478,P=0.000).3.4 RI 3.4.1The RI was much greater in healthy control group than test group(P<0.05).3.4.2Compared with healthy control group,the RI was much smaller in each activity group(P<0.05).3.4.3Compared with healthy control group,the RI was much smaller in early-phase group(P<0.05).3.4.4Compared with healthy control group,the RI was much smaller in each plaque group(P<0.05).3.4.5 There was a positive correlation between RI and SLEDAI in test group(r=0.302,P=0.019).4 Correlation between carotid atherosclerosis and serum level of angiogenic factor 4.1 There was a positive correlation between CIMT and serum level of VEGF,VEGF165,PIGF.4.2 There was a negtive correlation between PSV and serum level of VEGF,PIGF.4.3 There was a negtive correlation between EDV and serum level of VEGF.4.4 There was no correlation between RI and serum level of VEGF,VEGF121,VEGF165,PIGF.3.3 EDV 5 Lipid metabolism 5.1 The serum level of TG was much higher in test group compared with healthy control group(P<0.05).5.2 The serum level of HDL was much higher in test group compared with healthy control group(P<0.05).6 The univariate regression analysis of 24 indicators,which included the age,duration,BMI,presence or absence of fever,a new rash and so on,indicated that older age,longer duration,ESR and hs-CRP increased,anti ds-DNA antibody positive can be the risk factors of SLE with thickened carotid intima-media.Conclusions:1 The patients of systemic lupus erythematosus can have increasingly thickness of carotid intima-media and early-onset atherosclerosis.2 VEGF、VEGF121、VEGF165 and PIGF may play a certain role in the pathogenesis of SLE patients with thickened carotid intima-media.3 Older age,longer duration,ESR and hs-CRP increased,anti ds-DNA antibody positive can be the risk factors of SLE with atherosclerosis. |
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