Metabolički sindrom kod pacijenata sa lupus nefritisom

Metabolički sindrom i lupus nefritis

  • Dr sc. med. Violeta Rabrenović Violeta Rabrenović Violeta S Rabrenović" violettarab@gmail.com
  • Milica Petrovic Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia
  • Milorad Rabrenovic Center for Hyperbaric Medicine, Military Medical Academy, Belgrade, Serbia.
  • Nemanja Rancic Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia.
Ključne reči: Ključne reči : lupus nefritis, metabolički sindrom, dislipidemija, aktivnost

Sažetak


Sažetak:

Uvod/cilj: Metabolički sindrom (MetS) kod bolesnika sa SLE, predstavlja  dodatno opterećenje
i loš prognostički faktor za nastanak ili pogoršanje ateroskleroze i za kardiovaskularne komplikacije.
Kod mnogih bolesnika sa lupus nefritisom (LN) MetS je često inicijalno već ispoljen.
Cilj našeg rada bio je  da utvrdimo učestalost i karakteristike MetS kod bolesnika sa LN, kao i
odnos komponenti Met Si aktivnosti lupus nefritisa.

Materijal i metode: Kliničko ispitivanje je obuhvatilo grupu od 67 pacijenata sa LN, 54 (80,59%) ženskog pola i 13 (19,41%) muškaraca, prosečnih godina starosti 42,86±14,46. Pacijenti su podeljeni u dve grupe : prva  sa MetS (35,82%)  i druga bez MetS (64,18%), pacijenti su imali aktivan LN (34-50,74%) i LN u remisiji  (33-49,25%). Pratili smo kliničke i biohemijske parametre od interesa.

Rezultati: Poredeći pacijente sa LN zbirno kao i one sa MetS i bez MetS, utvrdili smo da su pacijenti sa MetS bili stariji (p = 0.001),  BMI  (p<0.001) i sistolni pritisak je bio viši  (p=0.002) i pušači su bili zastupljeniji u ovoj grupi (p<0.001). U analizama povišeni trigliceridi  (p<0.001) i  kreatinin (p=0.027) i snižen  albumin (p=0.050) i GFR  (p= 0.020) su zapaženi u grupi sa MetS.  MetS  je bio  zastupljen kod 44,11% pacijenata sa aktivnim LN i  kod 27.7% sa LN u remisiji. Najzastupljeniji parameter MetS bila arterijska hipertenzija (76.6%) koja značajno korelirala sa GFR i kreatininom;  hipertrigliceridemija (47.8%) koja je korelirala sa anti ds DNA At,  eritrociturijom, proteinurijom i SLEDAI/r indeksom ;  snižen HDL holesterol (28.4%) koji je korelirao značajno sa albuminom,  C3 i anti ds DNA At.

Zaključak: Kod naših pacijenata sa LN, MetS je bio povezan sa starijim životnim dobom, poremćjem bubrežne funkcije i pušenjem. Najzastupljeniji parameter MetS kod pacijenata sa LN bila je arterijska hipertenzija i dislipidemija koja je značajno korelirala sa parametrima aktivnosti bolesti, što upućuje na povećan rizik od kardiovaskularnin komplikacija u ovoj grupi bolesnika. 

 

 

Reference

References


1. Yen EY,  Singh RR . Brief report: Lupus-An unrecognized leading cause of death in young females: a population-based study using nationwide death certificates, 2000-2015. Arthritis Rheumatol 2018; 70: 1251–5.


2, Bernatsky S, Boivin JF, Joseph L, Manzi S, Ginzler E, Gladman DD, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum 2006; 54(8): 2550-7. 


3.  Barbhaiya M, Feldman CH, Chen SK, Guan H, Fischer MA, Everett BM, Costenbader KH. Comparative Risks of Cardiovascular Disease in Patients With Systemic Lupus Erythematosus, Diabetes Mellitus, and in General Medicaid Recipients. Arthritis Care Res (Hoboken) 2020; 72(10): 1431- 9.


4. Parker B, Ahmad Y, Shelmerdine J, Edlin H, Yates AP, Teh LS, Bruce IN. An analysis of the metabolic syndrome phenotype in systemic lupus erythematosus. Lupus 2011; 20(14):1459-65. 


5. Mok CC, Poon WL, Lai JP, Wong CK, Chiu SM, Wong CK, et al. Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus. Scand J Rheumatol 2010; 39(1): 42-9.


6. Parker B, Urowitz MB, Gladman DD, Lunt M, Bae SC, Sanchez-Guerrero J, et al. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 2013; 72(8): 1308-14. 


7. Mok CC, Tse SM, Chan KL, Ho LY. Effect of the metabolic syndrome on organ damage and mortality in patients with systemic lupus erythematosus: a longitudinal analysis. Clin Exp Rheumatol 2018; 36(3): 389-95.


8.  Parker B, Urowitz MB, Gladman DD, Lunt M, Donn R, Bae SC, et al. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 2015;74(8):1530-6. 


9. Sun EY, Alvarez C, Sheikh SZ. Association of Lupus Nephritis With Coronary Artery Disease by ISN/RPS Classification: Results From a Large Real-world Lupus Population. ACR Open Rheumatol 2019; 1(4): 244-50.


10. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol  2019; 71(9): 1400-12.


11.Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erithematous revisited. J Am Soc Nephrol 2004; 15:241-50.


12. Gladman DD, Ibañez D, Urowltz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002; 29(2): 288–91.


13. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9): 604-12.


14. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity: Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120: 1640-5.


15. McMahon M, Seto R, Skaggs BJ. Cardiovascular disease in systemic lupus erythematosus. Rheumatol Immunol Res 2021; 2(3): 157-72.


16. El-Magadmi M, Bodill H, Ahmad Y, Durrington PN, Mackness M, Walker M, et al. Systemic lupus erythematosus: an independent risk factor for endothelial dysfunction in women. Circulation 2004; 110: 399-404.


17. Ding X, Xiang W, He X. IFN-I Mediates Dysfunction of Endothelial Progenitor Cells in Atherosclerosis of Systemic Lupus Erythematosus. Front Immunol 2020;11: 581385. 


18. Lu X, Wang Y, Zhang J, Pu D, Hu N, Luo J, et al. Patients with systemic lupus erythematosus face a high risk of cardiovascular disease: A systematic review and Meta-analysis. Int Immunopharmacol 2021; 94: 107466.


19. Katz G, Smilowitz NR, Blazer A, Clancy R, Buyon JP, Berger JS. Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients. Mayo Clin Proc 2019; 94(8): 1436-43.


20. Sharma SK, Rathi M, Sahoo S, Prakash M, Dhir V, Singh S. Assessment of premature atherosclerosis in systemic lupus erythematosus patients with and without nephritis. Lupus 2016 ; 25(5): 525-31. 


21. Rizk A, Gheita TA, Nassef S, Abdallah A. The impact of obesity in systemic lupus erythematosus on disease parameters, quality of life, functional capacity and the risk of atherosclerosis. Int J Rheum Dis 2012;15(3): 261-7. 


22. Versini M, Jeandel PY, Rosenthal E, Shoenfeld Y. Obesity in autoimmune diseases: not a passive bystander. Autoimmun Rev 2014; 13(9): 981-1000. 


23. Kang JH, Xu H, Choi SE, Park DJ, Lee JK, Kwok SK, et al. Obesity increases the incidence of new-onset lupus nephritis and organ damage during follow-up in patients with systemic lupus erythematosus. Lupus 2020; 29(6): 578-86. 


24. Hanly JG, O'Keeffe AG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, et al.. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford) 2016; 55(2): 252-62.


25. Ajeganova S, Gustafsson T, Lindberg L, Hafström I, Frostegård J. Similar progression of carotid intima-media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients. Lupus Sci Med 2020; 7(1): e000362. 


26. Fotakis P, Kothari V, Thomas DG, Westerterp M, Molusky MM, Altin E, et al. Anti-Inflammatory Effects of HDL (High-Density Lipoprotein) in Macrophages Predominate Over Proinflammatory Effects in Atherosclerotic Plaques. Arterioscler Thromb Vasc Biol 2019; 39(12): e253-e272. 


27. Lin YJ, Chien CC, Ho CH, Chen HA, Chen CY. Increased risk of type 2 diabetes in patients with systemic lupus erythematosus: A nationwide cohort study in Taiwan. Medicine (Baltimore) 2022; 101(51): e32520.


28. Salmasi S, Sayre EC, Antonio Aviña-Zubieta J, Esdaile JM, De Vera MA. Adherence to Antimalarial Therapy and Risk of Type 2 Diabetes Mellitus Among Patients With Systemic Lupus Erythematosus: A Population-Based Study. Arthritis Care Res (Hoboken) 2021 ; 73(5): 702-6.


29. Bultink IE, Turkstra F, Diamant M, Dijkmans BA, Voskuyl AE. Prevalence of and risk factors for the metabolic syndrome in women with systemic lupus erythematosus. Clin Exp Rheumatol 2008;26(1): 32-8.


 

Objavljeno
2024/02/23
Rubrika
Original paper