系统性红斑狼疮合并冠状动脉疾病患者冠状动脉病变及临床分析

Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease

目的阐述系统性红斑狼疮（SLE）合并冠状动脉疾病患者的临床特征和冠状动脉表现。方法1999年1月至2009年10月在北京协和医院住院的年龄≥18岁的SLE患者共2877例，其中男性363例，女性2514例。对在SLE发病之后并发冠状动脉疾病的33例患者的临床资料及其中20例患者的冠状动脉病变特征进行回顾性分析。结果SLE患者出现冠状动脉疾病年龄23～74岁，平均（50．7±12．8）岁，SLE和冠状动脉疾病发病间隔平均（8．0±7．1）年。男性SLE患者冠状动脉疾病发生率有高于女性的趋势[2．48％（9／363）比0．95％（24／2514），P=0．022]。继发抗磷脂综合征（APS）患者冠状动脉疾病发生率明显增加[5．76％（8／139）比0．91％（25／2738），P〈0．001]。24例患者冠状动脉疾病的临床表现为心肌梗死；冠状动脉造影可见血管闭塞、狭窄、瘤样扩张和急性血栓形成，75．0％（15／20）的病例为多支病变。结论男性和继发抗磷脂综合征SLE患者冠状动脉疾病发生率高；SLE合并冠状动脉疾病者冠状动脉病变广泛，常常发生心肌梗死。

Objectives To observe the clinical and coronary＂ features of patients with systemic lupus erythematosus （SLE） and coronary artery disease （CAD）. Methods Among 2877 SLE inpatients （ age ≥ 18 years, male 363, female 2514） admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [ mean age （50. 7 ± 12.8） years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed. Results The incidence of CAD was significantly higher in male SLE patients than in female patients [ 2.48% （9/363） vs. 0. 95% （24/2514）, P = 0. 022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [ 5.76% （ 8/139 ） vs. 0. 91% （25/2738）, P 〈0. 001]. Myocardial infarction was the major form of CAD （24/33）. Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi- vessel lesions was found in 75.0% （15/20） patients with SIrE and CAD. Conclusions Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.