系统性红斑狼疮患者心血管事件发生的回顾调查:879例系统性红斑狼疮横断面研究

Cardiovascular risk profile in systemic lupus erythematosus: a cross-sectional study of 879 patients

本研究目的在于了解系统性红斑狼疮（systemic lupus erythematosus，SLE）患者心血管疾病（cardiovascular diseases，CVD）患病率情况和病变特点，并寻找SLE并发CVD的危险因素。方法 采用回顾性横断面研究，收集患者临床资料，包括人口学资料、病程、临床表现、治疗方案、肾脏病理、eGFR（MDRD方程计算）、SLEDAI评分及实验室检查结果。心脏超声检查测量心脏腔径及心功能参数，分析SLE患者心脏结构和功能异常的患病率、病变特点及其影响因素。临床上有肾脏受累表现者（蛋白尿、血尿、或细胞管型等），诊断为狼疮性肾炎，根据患者住院资料确定是否有心血管疾病。结果 879例系统性红斑狼疮患者中，85例合并CVD，患病率为9.7%。按年龄分层后， ≦ 19岁，20~39岁，40~59岁， ≧ 60 岁患者的 CVD 患病率分别为 5.8%，9.0%，14.0%，20.0%，CVD 的患病率随着年龄的升高而增加（P=0.002）。狼疮性肾炎患者CVD患病率显著高于非狼疮性肾炎患者（P=0.001）。85例CVD患者中，左心室肥厚20例（23.5%），充血性心力衰竭42例（49.5%），脑卒中17例（20.0%），心绞痛3例（3.5%），外周血管疾病3例（3.5%）。CVD患者狼疮病程及激素使用时间均显著长于非CVD患者（P=0.002，0.026），收缩压也高于非CVD患者（P=0.0006）。然而CVD患者eGFR显著低于非 CVD患者（P=0.001）。CVD患者血清HDL显著低于非CVD患者（P=0.007）。logistic多因素回归分析表明收缩压、eGFR、血清HDL、病程、活动度、血清补体及超敏-C反应蛋白是SLE并发CVD的危险因素（P=0.033）。结论 SLE患者CVD患病率较高，并随着年龄的增加而升高。狼疮肾炎患者CVD患病率高于非狼疮肾炎患者。收缩压、eGFR、血清HDL、病程、疾病活动度、血清补体C3、超敏-C反应蛋白是SLE患者发生CVD的危险因素。

Objective To investigate the prevalence of cardiovascular diseases（CVD） in patients with systemic lupus erythematosus（SLE） and estimate the associated risk factors for CVD.Methods This cross-sectional study was conducted in 879 SLE patients treated in our hospital between March,2006 and March,2011.The demographic data and the clinical data including SLE duration,therapeutic regimen,renal pathological data,estimated glomerular filtration rate（eGFR）,SLE Disease Activity Index（SLEDAI）,and associated biochemical parameters were analyzed. Cardiovascular ultrasound was used for detecting and analyzing the cardiovascular structural and functional abnormalities.Results Eighty-five cases of CVD were found in the 879 SLE cases（9.7%）.After age stratification,CVD was identified in 5.8%,9.0%,14.0% and 20.0% in SLE patients aged ≤19,20-39,40-59 and ≥60 years,respectively, showing a tendency to increase with age（P=0.002）.The prevalence of CVD differed significantly between patients with and those without lupus nephritis（P=0.001）.Among the 85 patients with CVD,23.5%（20/85） had left ventricular hypertrophy,49.5%（42/85） had congestive heart failure,20.0%（17/85） had stroke,3.5%（3/85） had angina pectoris,and 3.5%（3/85） had peripheral CVD.Compared to those without CVD,patients with CVD had a longer SLE duration（P=0.002）,a longer time of steroids treatment（P=0.026）,a higher blood pressure（P=0.0006）,a lower eGFR（P=0.001）,and a lower concentration of HDL（P=0.007）.Logistic regression analysis showed that SBP,eGFR,HDL,SLE duration, SLEDAI index,serum C3 and hs-CRP were the risk factors for CVD in SLE patients（P=0.033）.Conclusion SLE is associated with a high risk of CVD which increases with age,and SLE patients with lupus nephritis have an even higher risk for CVD.SBP,eGFR,HDL,SLE duration,SLEDAI index,serum C3 and hs-CRP are the risk factors for CVD in SLE patients.