类风湿关节炎心脏损害36例临床分析

Clinical Analysis of 36 Patients of Rheumatoid Arthritis with Cardiac Involvement

目的探讨类风湿关节炎心脏损害的特点及诊断方法。方法收集2006年6月-2010年5月类风湿关节炎住院患者121例,根据检查结果分为心脏损害组和无心脏损害组。分析年龄、性别、病程及疾病活动与类风湿关节炎心脏损害的相关性。结果 121例类风湿关节炎患者中心脏损害36例(29.8%),其中心包炎12例(33.3%),心电图ST-T缺血性改变8例(22.2%),心律失常7例(19.4%),瓣膜病变5例(13.9%),心肌损害3例(8.3%),冠状动脉炎1例(2.8%)。14例(38.9%)出现临床症状,主要表现为活动后轻度心悸胸闷。心脏损害组类风湿因子(RF)滴度、血沉(ESR)明显高于无心脏损害组。结论类风湿关节炎心脏损害并不少见,且与疾病活动相关。超声心动图在诊断类风湿关节炎心脏损害方面具有重要价值。

Objective To evaluate the features and diagnosis of the cardiac involvement caused by rheumatoid arthritis （RA）. Methods One hundred and twenty four RA inpatients from June 2006 to May 2010 were enrolled in this study. The patients were divided into cardiac involvement group and non cardiac involvement group according to the test results. Results The incidence of cardiac involvement caused by RA was 29.8% （36/121）, in which pericarditis accounted for 33.3% （ 12/36 ）, ECG STT ischemic changes for 22.2% （ 8/36 ）, cardiac arrhythmia for 19.4% （ 7/36 ）, cardiac valve disease for 13.9% （ 5/36 ） , myocardial damage for 8.3 % （3/36） and coronaritis for 2.8% （1/36）. Symptoms such as mild palpitation and chest tightness after the movements were observed in 38.9% （14/36）. The rheumatism factor（RF） titer and erythroeyte sedimentation rate（ESR） in the cardiac involvement group were both significantly higher than that in the non cardiac involvement group. Conclusion The cardiac involvement caused hy RA is not unusual, and relate with the activity of RA. The emphasis of echocardiography has a great value in the diagnosis of cardiac involvement in patients with RA.