干燥综合征的心血管损害

Cardiac manifestations in Sjogren syndrome

目的分析总结原发及继发性干燥综合征的心脏表现及其相关因素。方法回顾性分析124例干燥综合征患者，总结其临床表现、血清学检查及心脏彩色超声结果，并分析各种心脏表现的相关因素。结果干燥综合征患者心脏受累多无明显临床症状，心脏彩色超声上主要表现为心包积液（20．2％）、左心室舒张功能减低（13．7％）、肺动脉高压（12．9％）、左心房增大（7．3％）、主动脉增宽（5．6％）、二尖瓣关闭不全（4．8％）、三尖瓣关闭不全（3．2％）、左心室增大（2．4％）、左心室收缩功能减低（0．8％）。心包积液组患者总补体CH50、补体C3、补体C4水平低于非心包积液组患者（P〈0．05），而抗干燥综合征抗原A抗体（SSA）阳性率、C反应蛋白（CRP）水平高于非心包积液组，进行logistic回归分析后仅有CRP具有统计学意义[P〈0．05，比值比（OR）0．976，95％可信区间（口）0．956～0．997]；左心室舒张功能减低与非左心室舒张功能减低组的年龄、CRP、CH50、免疫球蛋白IgM均有明显差异（P〈0．05），回归分析仅有年龄与舒张功能减低有明显相关性（P〈0．005，OR0．884，95％C10．811～0．964）。肺动脉高压组患者1球蛋白水平高于非肺动脉高压组（P〈0．05），但两组间肺间质纤维化发生率无差别。结论干燥综合征患者心脏受累并不少见，心包积液、肺动脉高压是其最常见的表现，心包积液与CRP水平相关；左心室舒张功能减低与心脏老化有关，可能与干燥综合征本身无关；而干燥综合征是否可直接累及心肌和瓣膜目前尚不明确。

Objective To analyze the cardiac manifestations of patients with primary and secondary Sjogren syndrome. Methods Clinical data （ clinical manifestations, serologic measurements, echocardiogram） of 396 patients with Sjogren syndrome who admitted to our hospital from 2004 -2007 were retrospectively analyzed. Patients with congenital, rheumatic and coronary heart diseases, hypertension and diabetes （n = 221 ） and patients with incomplete clinic data （n = 51 ） were excluded. Results A total of 124 cases were included in this analysis （ mean age 47.4 years old; 5 males; average disease duration 85.5 months）. Cardiac involvement in Sjogren syndrome is usually asymptomatic. Pericardial effusion （PE） were evidenced in 20. 2%, left ventricular diastolic dysfunction （LVDD） in 13.7%, pulmonary artery hypertension （PAH） in 12. 9%, left atrium enlargementin 7. 3%, mitral insufficiency in 4. 8%, aortic dilation in 5.6%, tricuspid insufficiency in 3.2%, left ventricular enlargement in 2. 4% and left ventricular systolic dysfunction in 0. 8% patients by echocardiography examinations. Patients with PE had significantly lower CH50, C3, C4 levels and significantly higher C reactive protein level （CRP） and SSA positive rate than patients without PE（all P 〈0. 05）. The serum level of CRP was significantly associated with PE （ OR 0. 976,95% CI 0. 956 -0. 997, P 〈 0. 05）. Age is positively correlated to LVDD （OR 0. 884,95% CI 0. 811 - 0. 964, P 〈 0. 005）. The gammaglobulin level is significantly higher in the PAH group than that in the non-PAH group （P 〈 0. 05 ）. Conclusions Cardiac involvement is not rare in patients with Sjogren syndrome. PE, LVDD and PAH are usual cardiac manifestations in these patients. The serum level of CRP is positively related to PE in these patients with Sjogren syndrome.