肺血管阻力对系统性红斑狼疮患者右心功能减退的预测效果

Novel Predictor for Evaluating Right Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus: Pulmonary Vascular Resistance

目的:探究超声心动图肺血管阻力(pulmonary vascular resistance,PVR)在预测系统性红斑狼疮(systemic lupus erythema-tosus,SLE)患者右心功能障碍中的价值。方法:将43例SLE患者根据超声心动图肺动脉收缩压(PASP)检测结果分为两组:A组(无肺动脉高压组,PASP≤30 mmHg,n=23);B组(肺动脉高压组,PASP>30 mmHg,n=20)。所有患者均接受相应实验室检查,采用超声心动图检测患者PVR及右室面积变化分数(fractional area change,FAC),并分析临床、实验室及心脏超声各项指标与右心功能减退的关系。结果:两组SLE患者中,12项超声指标差异具有统计学意义(P<0.01)。将FAC<35%作为应变量,经年龄和性别调整后行多元Logistic回归分析发现,FAC的降低仅与PVR相关[风险指数(odds ratio)=9.85,P=0.04]。受试者工作特征曲线(receiver operator characteristic curve,ROC)分析显示,PVR>1.45 wood单位预测FAC<35%的曲线下面积(area under the curve,AUC)为0.91(P<0.001),敏感性为92%,特异性为68%。结论:PVR预测右心功能障碍的准确性及敏感性优于PASP,是评估SLE患者疗效和预后的新的预测因子。

Objective：To evaluate the value of ultrasonic cardiogram pulmonary vascular resistance（PVR） in the prediction of right ventricular dysfunction in patients with systemic lupus erythematosus（SLE）.Methods：Forty-three SLE patients were divided into two groups according to the pulmonary artery systolic pressure（PASP） measured by echocardiography： group A（23 patients with PASP ≤ 30 mmHg） and group B（20 patients with PASP 30 mmHg）.All patients underwent corresponding laboratory tests.PVR and fractional area change（FAC） were detected by ultrasonic cardiogram.Results： There were significant differences in 12 indexes between the two groups（P0.01）.Taking FAC35% as a dependent variable,after adjustment for age and gender,PVR was still related to right ventricular dysfunction（odds ratio= 9.85,P= 0.04）by multivariate logistic regression analysis.Receiver operator characteristic curve（ROC） analysis showed that the sensitivity and specificity for PVR1.45 wood in predicting FAC 35% were 92% and 68%（AUC： 0.91,P0.001）,respectively.Conclusions： PVR is a more accurate and sensitive predictor for right ventricular dysfunction compared with PASP.