Retinal Vasculitis and Stroke Risk in Patients with Systemic Lupus Erythematosus

To assess the association between retinal vasculitis and cerebral stroke and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE with and without retinal vasculitis were identified in the TriNetX research network. Initially, there were 337,411 patients with SLE and no retinal vasculitis and 570 patients with SLE and retinal vasculitis. After matching to balance age, sex, race, and cardiac risk factors, 540 patients remained in each group. Outcomes evaluated included stroke risk and mortality over a 20-year follow-up. Statistical analysis included risk ratios (RR), Kaplan-Meieranalysis, and Cox proportional hazards modeling. The 1-year stroke risk was 1.9% in patients without retinal vasculitis and 4.5% with retinal vasculitis. At 5 years, risks were 4.7% and 9.1%; at 10 years, 5.6% and 13.2%; and at 20 years, 7.5% and 17.1%, respectively (p p = 0.002). Cox regression analysis of stroke risk showed a hazard ratio for retinal vasculitis of 2.25 (95% CI: 1.72–2.94, p p = 0.3626). The presence of retinal vasculitis in patients with SLE significantly increases the risk of stroke over a 20-year period, highlighting the importance of early identification and timely referral of this group of patients.本研究旨在评估系统性红斑狼疮（systemic lupus erythematosus, SLE）患者合并视网膜血管炎（retinal vasculitis）与脑卒中、全因死亡率之间的关联。研究团队在TriNetX研究网络中筛选出合并与未合并视网膜血管炎的系统性红斑狼疮患者。初始队列中，未合并视网膜血管炎的系统性红斑狼疮患者共337411例，合并视网膜血管炎者共570例。经年龄、性别、种族及心脏危险因素匹配以均衡两组基线特征后，每组各保留540例患者。本研究的评估结局为20年随访期内的脑卒中发生风险与全因死亡率。统计学分析方法包括风险比（risk ratios, RR）、Kaplan-Meier分析以及Cox比例风险回归模型。未合并视网膜血管炎组患者的1年脑卒中发生风险为1.9%，合并视网膜血管炎组为4.5%；随访5年时，两组风险分别为4.7%与9.1%，10年时为5.6%与13.2%，20年时为7.5%与17.1%（P=0.002）。针对脑卒中风险的Cox回归分析显示，合并视网膜血管炎对应的危险比为2.25（95%置信区间：1.72~2.94，P=0.3626）。系统性红斑狼疮患者合并视网膜血管炎可显著升高20年随访期内的脑卒中发生风险，该结果凸显了对该类患者进行早期识别与及时转诊的重要性。