系统性红斑狼疮合并冠心病患者的临床分析

Clinical Analysis of Systemic Lupus Erythematosus Patients Combined With Coronary Artery Disease

目的:总结我院系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)合并冠心病患者的临床特征,以提高临床认识。方法:回顾分析2002-01至2010-06期间我院近8年住院的系统性红斑狼疮合并冠心病患者的临床资料,比较其临床和实验室指标特点。结果:76 457例次冠心病患者中合并SLE患者26例次(17例),占住院率0.03%。其中有15例患者先诊断SLE合并冠心病且资料完整被纳入分析,女男比2/1,SLE发病年龄(40.8±2.3)岁,冠心病首发病年龄在女性(55.60±9.10)岁,男性(55.00±13.67)岁。女性闭经年龄(47.4±5.7)岁(36～55岁)。其它主要合并症:心肌梗死14例(急性心肌梗死4例,陈旧性心肌梗死10例),高血压7例,高脂血症13例,心力衰竭7例,尿蛋白阳性7例,血沉快7例。冠状动脉(冠脉)造影/计算机断层摄影术(CT)示:三支病变7例,冠脉闭塞10例。超声心动图示:心脏瓣膜关闭不全者8例,中量反流3例均为二尖瓣。心包渗出(积液)1例。X线胸片示:主动脉结宽10例,肋膈角变钝者6例。4例行介入治疗,2例失败,4例择期行搭桥术,其中脑复苏困难1例。结论:SLE合并冠心病患者的冠脉病变广泛、严重,闭塞率高,易合并心功能不全。SLE女性绝经早,发生冠脉病变年龄早,多有心脏瓣膜关闭不全、肺、胸膜、肾脏、神经系统累及。SLE活动可能是患者发生心脏事件的重要危险因素。

Objective：To summarize the clinical characteristics of systemic lupus erythematosus （SLE）patients combined with coronary artery disease（CAD） in order to improve the clinical recognition for such patients. Methods：We retrospectively analyzed 15 SLE patients combined with CAD from 76457 CAD eases for their clinical features and laboratory parameters. All patients were admitted and treated in our hospital from 2002 to 2010. Results：15 patients were diagnosed for SLE at the mean age of（40. 8±2.3） years,there were 5 male suffered from primary CAD at（55.00±13.67）years and 10 female with the primary CAD at（55.6±9.10）years,with the menopause at（47.44±5.70） years. The major complications for those 15 SLE patients were dyslipidaemia： 13 cases, hypertension ：7 cases, myocardial infarction （ MI ） ： 14 cases, congestive heart failure （HF） ： 7 cases, proteinuria ：7 cases, abnormal ESR： 7 cases. Coronary angiagraphy and CT examination presented that 3-vessel lesion：7 cases, occluded vessels.. 10 cases. Echocardiography indicated that mitreL valve regurgitation：8 cases,pericardial effusion：l ease. Chest X-ray showed that enlarged aortic node： 10 cases,pleural effusion：6 cases. 4 patients received percutaneous coronary intervention and 2 of them failed ,4 patients had coronary artery bypass graft surgery and 1 of them with the difficulty for brain recovery. Conclusion ：SLE patients combined with CAD could suffer from severe coronary lesions and frequent vessel occlusion, they usually complicated with HF. Female patients may have earlier menopause and earlier CAD. SLE often involved in kidney, pleural and cardiac valve, the active SLE might be an important risk factor for cardiac events.