Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus

作者：Takaya Kitano, Tôru Hirano, Shuhei Okazaki, Eri Itotagawa, Yoshiki Yagita, Yoshitaka Morita, Akihiro Watanabe, Daisuke Takahashi, Manabu Sakaguchi, Hiroshi Fujiwara, Kenichi Todo, Tsutomu Sasaki, Atsushi Kumanogoh, Hideki Mochizuki · 发表于：Internal Medicine · 年份：2022 · DOI：10.2169/internalmedicine.9228-21 · 被引用次数：8 · 研究领域：Systemic Lupus Erythematosus Research、Atherosclerosis and Cardiovascular Diseases、Antiplatelet Therapy and Cardiovascular Diseases

Objective The underlying pathophysiology varies according to stroke subtype. However, stroke heterogeneity among patients with systemic lupus erythematosus (SLE) remains unstudied. We hypothesized that the contribution of SLE to stroke might vary according to its subtype and investigated the associations of SLE and various stroke subtypes. Methods Diagnostic codes and electronic medical records were used to identify 70 patients with SLE who developed acute cerebral infarction or intracerebral hemorrhaging at four tertiary referral hospitals between 2008 and 2018. Intracerebral hemorrhaging was classified as lobar or deep, while cerebral infarction was classified according to the SSS-TOAST criteria. Physician notes were used to identify SLE activity, and their prevalences were compared among stroke subtypes. Outcomes were collected from the patients' medical records. Results The most common stroke subtype in patients with SLE was that of undetermined causes (31%), followed by small artery occlusion (16%), cardioaortic embolism (13%), other causes (11%), lobar hemorrhaging (10%), deep hemorrhaging (10%), and large artery atherosclerosis (9%). Stroke onset occurred during a period of high SLE activity in 21 patients (30%). The proportion of patients with high SLE activity varied according to stroke subtype (p=0.039) and was highest for cerebral infarction with undetermined causes. Stroke recurrence or death was observed in 40% of patients within 5 years after the initial stroke ...