大动脉炎成人患者心脏扩大的临床分析

Clinical study on cardiomegaly in adult patients with Takayasu arteritis

目的了解大动脉炎(TA)合并心脏扩大的临床特点,探讨其潜在的心脏损害原因。方法回顾性研究2000年至2012年入院的大动脉炎成人患者,分别随机选择心脏扩大者59例与心脏正常大小者89例,共144例TA患者。所有患者均行红细胞沉降率(ESR)与C反应蛋白(CRP)、超声心动图和主动脉或肺动脉造影或CT检查。47例心脏扩大组行冠状动脉造影术或冠脉CT检查。2例扩张型心肌病行心脏磁共振(CMR)检查。结果 TA合并心脏扩大患者的年龄、病程、吸烟率、高血压、左室射血分数(LVEF)减低者、ESR、CRP均显著高于心脏不大组(P<0.05)。导致心脏扩大的主要损害类型依次是高血压24例(40.7%)、瓣膜病21例(35.6%)、肺动脉高压12例(20.3%)、扩张型心肌病11例(18.6%)、冠状动脉病变6例(10.2%)、复合病变15例(25.4%)。结论为预防心脏并发症,应早期诊断TA,确诊后即严格控制炎症、降压。当出现心脏并发症后,积极治疗相关并发症,必要时可以行瓣膜置换术、血运重建术。但控制炎症始终是TA所有治疗的基石。

Objective To study the clinical features resulting from cardiomegaly in adult patients with Takayasu arteritis（TA）,and to discuss its potential impairment in heart.Methods The clinical data of 144 hospitalized patients with TA（59 patients with cardiomegaly and 85 patients with normal sized heart） from 2000 to 2012 were retrospectively reviewed and analyzed.Erythrocyte sedimentation rate（ESR）,C reactive protein（CRP）,echocardiogram and angiography or computed tomographic（CT） angiography of aorta and pulmonary arteries were examined in all patients.47 patients with cardiomegaly were detected by coronary angiography or CT angiography.Two patients with cardiomegaly were detected by cardiac magnetic resonance（CMR） imaging.Results In this study,there was significant difference in age,course of disease,prevalence of smoking habit and hypertension and reduced left ventricular ejection fraction,ESR and CRP between TA patients with cardiomegaly and TA patients without cardiomegaly.Meanwhile,it showed that factors contributed to cardiac impairment including hypertension in 24 patients（40.7%）,valvular heart disease in 21 patients（35.6%）,pulmonary hypertension in 12 patients（20.3%）,dilated cardiomyopathy in 11 patients（18.6%）,coronary heart disease in 6 patients（10.2%）,mixed diseases in 15 patients（25.4%）.Conclusion It is important for TA patients that early diagnosis and strictly control of inflammation and blood pressure may be helpful in avoidance of cardiac impairment.When cardiac impairment is developed,active treatment should be exerted to treat related complications,even including valve replacement and revascularization if necessary.Nevertheless,control of inflammation is forever the cornerstone of all therapy in TA patients with cardiac impairment.