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INFLUENCE OF THE IMMUNE STATUS, LIPID FACTORS AND DRUG THERAPY ON SUBCLINICAL ATHEROSCLEROSIS PROGRESSION AND DEVELOPMENT OF THE CARDIO-VASCULAR DISEASES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Summary. Objective. To investigate the influence of immune and lipid factors, use of immunosuppressive therapy on the progression of subclinical atherosclerosis in patients with systemic lupus erythematosus (SLE) and their link to the development of cardio-vascular diseases in these patients.
Methods. The prevalence of traditional risk factors for the cardio-vascular diseases development; influence of the immune, cytokine, lipid factors, use of different immunosuppressive and anti-inflammatory therapy on the progression of subclinical atherosclerosis and development of cardio-vascular diseases has been investigated in 80 SLE patients (all women, <50 years old), by use of 2-years monitoring of the immune, cytokine and lipid profile, vascular wall and cardio-vascular system status.
Results. It is determined that intima-media thickness (IMT) and frequency of the carotid atherosclerotic plaque (AP) formation in SLE patients is significantly higher than in control group; subclinical atherosclerosis accelerates in patients with longer SLE duration and higher damage index accompanied by the decreased effectiveness of the immunosuppressive and anti-inflammatory therapy, severe immunologic and cytokine disturbances, systemic endothelium activation which lead to increased frequency of the cardio- and cerebrovascular disease and events.
Conclusion. Subclinical atherosclerosis in young SLE female patients with chronic disease accelerates in patients with longer SLE duration and higher damage index, decreased effectiveness of the immunosuppressive and anti-inflammatory therapy, which leads to increase of CD-4 quantity and higher CD-4/CD-8 ratio, accumulation of the apoptic CD-95 lymphocytes and deficit of CD-25 lymphocytes and significant cytokine disbalance with the normal or moderate proatherogenic lipid profile changes. Accelerating increase of the carotid IMT (>0.12 mm/year) leads to significant increase of the vascular events (stroke, transit ischemic attack, arterial hypertension) and frequency of AP and left ventricular diastolic dysfunction development. Use of azatioprin decreases the carotid subclinical atherosclerosis progression, frequency of AP and vascular events development independent from SLE duration; use of the hydroxychloroquine drugs is more effective for treatment of patients with <5 years SLE duration.