结缔组织病致心脏损害的对比分析

Analysis and comparison of cardiac lesion associated with connective tissue disease

目的:探讨系统性红斑狼疮(SLE)及类风湿关节炎(RA)对心血管系统的影响。方法:收集2002年1月～2009年11月包头地区确诊的150例SLE及219例RA患者,对其临床资料进行回顾性分析。结果:①SLE及RA心脏损害的发生率分别为43.3%及32.4%,差异无统计学意义(P>0.05)。②SLE及RA心脏损害组平均年龄、平均病程明显大于无心脏损害组(P<0.05),心脏损害组中RA平均年龄大于SLE,差异有统计学意义(P<0.05)。③心脏损害患者中27例SLE及32例RA无心脏病相关症状及体征,经心脏超声、心电图检查确诊。④SLE组心前区不适、心律失常、心包病变的发生率明显高于RA组,差异有统计学意义(均P<0.05)。⑤SLE、RA心脏损害组CRP平均值均明显高于无心脏损害组,差异有统计学意义(均P<0.05)。结论:SLE、RA并发心脏损害早期症状轻或无症状而易漏诊,应重视临床观察,及时行心电图、超声心动图及CRP检查,有助于早期发现心脏病变,降低心血管事件的死亡率。

Objective：To investigate the cardiovascular involvement in patients with systemic lupus erythematosus （SLE） and rheumatoid arthritis （RA）. Methods：A total of 150 patients with SLE and 219 patients with RA admitted to the hospitals in Baotou region from January 2002 to November 2009 were evaluated. The clinical data of these patients were analyzed retrospectively. Results：①The cardiac damage occurred in 43.3% of SLE patients and 32.4% of RA patients,and there was no significant difference （P〉0.05）. ②In SLE and RA groups,the average age of the patients with cardiac damage was significantly older than that of patients without cardiac damage （P〈0.05）. The average duration of the disease time course in patients with cardiac damage was significantly longer than that of patients without cardiac damage （P〈0.05）. Within the two groups with cardiac damage with SLE or RA,the age of the RA group was older than the SLE group （P〈0.05）. ③Among patients with cardiac damage,27 cases of SLE and 32 cases of RA had few apparent clinical manifestations,which were diagnosed through routine ECG and echocardiogram. ④The incidence of precordium pain,arrhythmia,and pericardiopathy in the SLE group was higher than that of RA group （all P〈0.05）. ⑤The CRP level in SLE and RA groups with cardiac damage were dramatically higher than that of patients without cardiac damage （all P〈0.05）. Conclusion：The SLE and RA groups with early stage cardiac damage are easily miss-diagnosed due to fewer apparent clinical manifestations. Therefore,observation of symptoms and physical examinations should be performed carefully through routine ECG,echocardiogram,and monitoring of CRP levels. These measures can increase the rate of the earlier diagnosis of CTD-induced cardiac damage,therefore decrease mortality due to cardiovascular attacks.