系统性红斑狼疮心脏损害的临床及危险因素分析
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摘要
目的了解系统性红斑狼疮(systemic lupus erythematosus, SLE)合并心脏损害患者的临床特征,并探讨SLE心脏损害的危险因素及其他脏器损害情况,为SLE合并心脏损害的临床诊疗提供依据。
方法收集2005年1月至2010年12月宁夏医科大学总医院确诊SLE合并心脏损害的住院患者的临床资料,以同期住院的无心脏损害的SLE患者作为对照,分析SLE心脏损害患者的临床特征;比较两组间临床和实验室检查的差异,通过Logistic回归分析初步探讨SLE心脏损害的危险因素;并通过比较两组间SLICC损伤指数(SDI)积分进一步了解其他脏器损害情况。
结果在114例SLE合并心脏损害患者中,超声心动图检查异常者107例,其中心包积液45例(45/114),占39.47%,瓣膜反流41例(41/114),占35.96%,左室舒张功能减低24例(24/114),占21.01%,心脏扩大20例(20/114),占17.5%,肺动脉压升高者11例(11/114),占9.65%。心电图检查异常者47例,其中窦性心动过速27例(27/114),占23.7%,ST-T异常22例(22/114),占19.3%,房室传导阻滞5例,窦性心动过缓3例,频发室性期前收缩、频发房性期前收缩各1例。
单因素分析显示,与系统性红斑狼疮患者心脏损害的相关因素包括:病程、发热、浆膜炎、神经精神狼疮、贫血、肾脏损害、SLEDAI≥10、抗Sm抗体、抗ds-DNA结合率、ANCA、补体C3、甘油三酯、高密度脂蛋白。经Logistic回归分析显示,系统性红斑狼疮患者合并心脏损害的危险因素包括:贫血、低补体C3、高密度脂蛋白降低。
结论1.合并贫血、低补体C3、高密度脂蛋白降低的SLE患者易出现心脏损害。2.合并心脏损害的SLE患者其他器官损害程度也较高,需及时全面的了解SLE脏器损害情况。
Objective To clarify clinical features of systemic lupus erythematosus (SLE)with cardiac involvement and to examine the clinical risk factors and prognostic impact of SLE with cardiac involvement ,using simple and reliable indices.
Methods The clinical data of SLE with cardiac involvement admitted to the Affiliated Hospital of Ningxia Med.Univ. from January,2005 to December,2010 were reviewed and matched with control patients. To analyze the clinical manifestation of SLE with cardiac involvement and compare with the two groups in clinical manifestation and immunological profiles,to discussion on the clinical risk factors of SLE with cardiac manifestations according to the multivariate factor analysis. End organ damage (SLICC) were recorded to judge the different prognosis.
Results There are 107 cases of abnormol UCG in 114 SLE patients with cardiac involvement , including pericardial effusion in 45 cases(39.47%),valve diseases in 41 cases(35.96%), left ventricular functional abnormality in 24 cases(21.01%) enlargement of the heart in 20 cases(17.5%),pulmonary hypertension in 11 cases (9.65%). There are 47 cases of abnormol ECG in 114 SLE patients with cardiac involvement,including sinus tachycardia in 27 cases(23.7%),ST segment and/or T wave (ST-T)ischemic changes of ECG in 22 cases (19.3%), AV Block in 5 cases, sinus bradycardia in 3 cases, 1 case of frequent Hypothalamic stimulation-induced Ventricular Extrasystale and 1 case of APB.
Univariate analysis showed that the course of disease、fever、oromeningitis、neuropsychiatric lupus、anemia、lupus nephritis、SLEDAI≥10、anti-Sm、anti-DNA、ANCA、complement C3、triglycerides、high density lipoprotein were associated with the happening of SLE cardiac involvement.And multivariate analysis showed that anemia、complement C3、high density lipoprotein were significantly associated with the happening of SLE cardiac involvement.
Conclusions 1..SLE patients who hadanemia、complement C3、high density lipoprotein were likely to develop cardiac involvement. 2.SLE patients with cardiac involvement had worse prognosis.
方法收集2005年1月至2010年12月宁夏医科大学总医院确诊SLE合并心脏损害的住院患者的临床资料,以同期住院的无心脏损害的SLE患者作为对照,分析SLE心脏损害患者的临床特征;比较两组间临床和实验室检查的差异,通过Logistic回归分析初步探讨SLE心脏损害的危险因素;并通过比较两组间SLICC损伤指数(SDI)积分进一步了解其他脏器损害情况。
结果在114例SLE合并心脏损害患者中,超声心动图检查异常者107例,其中心包积液45例(45/114),占39.47%,瓣膜反流41例(41/114),占35.96%,左室舒张功能减低24例(24/114),占21.01%,心脏扩大20例(20/114),占17.5%,肺动脉压升高者11例(11/114),占9.65%。心电图检查异常者47例,其中窦性心动过速27例(27/114),占23.7%,ST-T异常22例(22/114),占19.3%,房室传导阻滞5例,窦性心动过缓3例,频发室性期前收缩、频发房性期前收缩各1例。
单因素分析显示,与系统性红斑狼疮患者心脏损害的相关因素包括:病程、发热、浆膜炎、神经精神狼疮、贫血、肾脏损害、SLEDAI≥10、抗Sm抗体、抗ds-DNA结合率、ANCA、补体C3、甘油三酯、高密度脂蛋白。经Logistic回归分析显示,系统性红斑狼疮患者合并心脏损害的危险因素包括:贫血、低补体C3、高密度脂蛋白降低。
结论1.合并贫血、低补体C3、高密度脂蛋白降低的SLE患者易出现心脏损害。2.合并心脏损害的SLE患者其他器官损害程度也较高,需及时全面的了解SLE脏器损害情况。
Objective To clarify clinical features of systemic lupus erythematosus (SLE)with cardiac involvement and to examine the clinical risk factors and prognostic impact of SLE with cardiac involvement ,using simple and reliable indices.
Methods The clinical data of SLE with cardiac involvement admitted to the Affiliated Hospital of Ningxia Med.Univ. from January,2005 to December,2010 were reviewed and matched with control patients. To analyze the clinical manifestation of SLE with cardiac involvement and compare with the two groups in clinical manifestation and immunological profiles,to discussion on the clinical risk factors of SLE with cardiac manifestations according to the multivariate factor analysis. End organ damage (SLICC) were recorded to judge the different prognosis.
Results There are 107 cases of abnormol UCG in 114 SLE patients with cardiac involvement , including pericardial effusion in 45 cases(39.47%),valve diseases in 41 cases(35.96%), left ventricular functional abnormality in 24 cases(21.01%) enlargement of the heart in 20 cases(17.5%),pulmonary hypertension in 11 cases (9.65%). There are 47 cases of abnormol ECG in 114 SLE patients with cardiac involvement,including sinus tachycardia in 27 cases(23.7%),ST segment and/or T wave (ST-T)ischemic changes of ECG in 22 cases (19.3%), AV Block in 5 cases, sinus bradycardia in 3 cases, 1 case of frequent Hypothalamic stimulation-induced Ventricular Extrasystale and 1 case of APB.
Univariate analysis showed that the course of disease、fever、oromeningitis、neuropsychiatric lupus、anemia、lupus nephritis、SLEDAI≥10、anti-Sm、anti-DNA、ANCA、complement C3、triglycerides、high density lipoprotein were associated with the happening of SLE cardiac involvement.And multivariate analysis showed that anemia、complement C3、high density lipoprotein were significantly associated with the happening of SLE cardiac involvement.
Conclusions 1..SLE patients who hadanemia、complement C3、high density lipoprotein were likely to develop cardiac involvement. 2.SLE patients with cardiac involvement had worse prognosis.
引文
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[3] Urowitz MB,Bookman AA,Koehler BE.et al.The bimodal mortality Pattern of SLE.Am[J].J Med,1976,60:221-225.
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