服用阿司匹林可降低sle心血管…

服用阿司匹林可降低狼疮患者心血管事件的发生率

作者：Iudici M， et al.
翻译：北医三院李常虹（changhongli@bjmu.edu.cn）

摘要（意大利）: 目的：系统性红斑狼疮（SLE）患者心血管疾病的发病率和死亡率显著高于普通人群。已知阿司匹林可降低普通高危人群的心血管事件发生率，但阿司匹林作为初级预防用于预防SLE患者心血管事件的疗效尚不清楚。
方法：连续入组SLE临床病例，在入组时SLE患者需满足1992年ACR和/或2012年SLICC有关SLE的分类诊断标准，且未经历过任何心血管事件。每次随访均记录心血管事件的发生情况。所有入组患者在初次随访时均加用阿司匹林。每次随访时均记录阿司匹林停用的原因和停用率。
结果：共纳入167例SLE患者，平均随访时间为8年。其中有146例患者规律服用了阿司匹林，21例患者拒绝服用或停用阿司匹林。在146例接受阿司匹林治疗的患者中有5次心血管事件发生（4.2次/1000人年），21例未接受阿司匹林治疗的患者中有4次心血管事件发生（30次/1000人年）。无心血管事件的比例在阿司匹林治疗组显著高于未接受阿司匹林治疗的患者。没有记录到有服用阿司匹林的相关不良反应。
结论：阿司匹林是一种安全的治疗方式，也许对于SLE患者预防心血管事件的发生有益。阿司匹林作为初级预防用药的地位有待通过前瞻性对照研究来进一步证实。
附全文：Abstract OBJECTIVES: Cardiovascular (CV) morbidity and mortality are significantly greater in SLE patients than in the general population. ASA is known to be associated with a decrease in the incidence of CV events in high-risk patients from the general population, but its efficacy as primary prophylaxis in SLE patients has not yet been investigated. METHODS: The clinical charts of SLE patients consecutively admitted to a tertiary centre who, at admission, satisfied 1992 ACR and/or 2012 SLICC classification criteria for SLE and had not experienced any CV event, were reviewed. The occurrence of any CV event was recorded at each visit. ASA was prescribed to all patients at first visit. The rate and reasons for ASA discontinuation were also recorded at each visit. RESULTS: One hundred and sixty-seven consecutive SLE patients were enrolled and followed up for a median of 8 years (range 1-14 years). Among them, 146 regularly took the medication (ASA-treated patients) and 21 refused to take or discontinued it (non-ASA-treated patients). Five CV events occurred in the 146 ASA-treated patients (4.2 per 1000 person-years) and four in the 21 non-ASA-treated patients (30 per 1000 person-years; P = 0.0007). The CV event-free rate was higher in ASA-treated than in non-ASA-treated patients (log-rank test χ(2) = 15.74; P = 0.0001). No relevant side-effect related to ASA was recorded. CONCLUSION: Low-dose ASA is a safe treatment and may be beneficial in the primary prophylaxis of CV events in SLE patients. Controlled, prospective studies are needed to provide a better definition of its role in these patients.
引自：Iudici M, Fasano S, Gabriele Falcone L, Pantano I, La Montagna G, Migliaresi S, Valentini G.Low-dose aspirin as primary prophylaxis for cardiovascular events in systemic lupus erythematosus: a long-term retrospective cohort study. Rheumatology (Oxford). 2016 Sep;55(9):1623-30. doi: 10.1093/rheumatology/kew231. Epub 2016 May 31.