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Abstract：
Ischemic cerebrovascular disease (ICVD) is one of the most common and severe complications in systemic lupus erythematosus (SLE). We aim to explore the risk factors for ICVD in SLE and to assess their associated clinical characteristics.
In this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann-Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal-Wallis test.
Of the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11-25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435-13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789-31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078-0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups.
Cutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.
In this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann-Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal-Wallis test.
Of the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11-25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435-13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789-31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078-0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups.
Cutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.
摘要：
缺血性脑血管病（ICVD）是系统性红斑狼疮（SLE）最常见和严重的并发症之一。我们旨在探讨SLE中ICVD的危险因素并评估其相关临床特征。
在这项研究中,纳入了2014年至2021年在我们中心住院的44例ICVD（ICVD-SLE）狼疮患者和80例年龄和性别匹配的无ICVD（非ICVD-SLE）狼疮患者。记录了一组全面的临床和社会人口统计学数据。在ICVD-SLE组,ICVD发生后90天的改良Rankin评分（mRS），脑部核磁共振,收集动脉超声检查结果。采用独立t检验或Mann-Whitney检验对连续变量进行分组比较,并对分类变量使用卡方检验或Fisher精确检验。采用多因素logistic回归分析SLE患者ICVD的危险因素。根据颅内动脉狭窄（ICAS）的分级，将ICVD-SLE患者分为三个亚组。通过单向ANOVA检验或Kruskal-Wallis检验进行亚组比较。
在44例ICVD患者中,45%患有大血管缺血性卒中,50%有症状腔隙性中风,9%有短暂性脑缺血发作。2例（4.5％）同时患有大血管缺血性中风和症状性腔隙性中风。多因素logistic回归分析显示皮肤血管炎(OR=7.36,95%CI=2.11~25.65),抗心磷脂抗体（aCL）（OR=4.38，95％CI=1.435-13.350），和狼疮抗凝物(LA)(OR=7.543,95%CI=1.789-31.808)是危险因素,羟氯喹（HCQ）治疗（OR=0.198，95％CI=0.078-0.502）是保护因素，在控制了混杂因素之后。在分析子组的过程中，除诊断延迟外,无颈内动脉闭塞(ICAS)组患者和重度ICAS组患者之间无显著差异.然而,中度ICAS组患者在SLE发生时年龄较大(P<0.01),诊断延迟较长(P<0.01)，低补体血症（P=0.05）和类固醇和HCQ治疗（分别为P=0.01，P=0.05）的百分比较低，MRS评分降低的趋势，颈动脉粥样硬化斑块发生率较高(P<0.01),与其他两个亚组相比。
皮肤血管炎和抗磷脂抗体（aPL）与ICVD的风险增加有关，而HCQ治疗可在SLE中提供对ICVD的保护。年轻狼疮患者的ICVD与补体介导的炎症和较差的预后相关，需要免疫抑制治疗，而老年患者的ICVD以中度ICAS和颈动脉粥样硬化斑块为特征。
在这项研究中,纳入了2014年至2021年在我们中心住院的44例ICVD（ICVD-SLE）狼疮患者和80例年龄和性别匹配的无ICVD（非ICVD-SLE）狼疮患者。记录了一组全面的临床和社会人口统计学数据。在ICVD-SLE组,ICVD发生后90天的改良Rankin评分（mRS），脑部核磁共振,收集动脉超声检查结果。采用独立t检验或Mann-Whitney检验对连续变量进行分组比较,并对分类变量使用卡方检验或Fisher精确检验。采用多因素logistic回归分析SLE患者ICVD的危险因素。根据颅内动脉狭窄（ICAS）的分级，将ICVD-SLE患者分为三个亚组。通过单向ANOVA检验或Kruskal-Wallis检验进行亚组比较。
在44例ICVD患者中,45%患有大血管缺血性卒中,50%有症状腔隙性中风,9%有短暂性脑缺血发作。2例（4.5％）同时患有大血管缺血性中风和症状性腔隙性中风。多因素logistic回归分析显示皮肤血管炎(OR=7.36,95%CI=2.11~25.65),抗心磷脂抗体（aCL）（OR=4.38，95％CI=1.435-13.350），和狼疮抗凝物(LA)(OR=7.543,95%CI=1.789-31.808)是危险因素,羟氯喹（HCQ）治疗（OR=0.198，95％CI=0.078-0.502）是保护因素，在控制了混杂因素之后。在分析子组的过程中，除诊断延迟外,无颈内动脉闭塞(ICAS)组患者和重度ICAS组患者之间无显著差异.然而,中度ICAS组患者在SLE发生时年龄较大(P<0.01),诊断延迟较长(P<0.01)，低补体血症（P=0.05）和类固醇和HCQ治疗（分别为P=0.01，P=0.05）的百分比较低，MRS评分降低的趋势，颈动脉粥样硬化斑块发生率较高(P<0.01),与其他两个亚组相比。
皮肤血管炎和抗磷脂抗体（aPL）与ICVD的风险增加有关，而HCQ治疗可在SLE中提供对ICVD的保护。年轻狼疮患者的ICVD与补体介导的炎症和较差的预后相关，需要免疫抑制治疗，而老年患者的ICVD以中度ICAS和颈动脉粥样硬化斑块为特征。
