系统性红斑狼疮患者并发心律失常的类型及相关危险因素分析

Types and risk factors of cardiac arrhythmias in patients with systemic lupus erythematosus

目的分析系统性红斑狼疮(SLE)患者并发心律失常的类型及相关危险因素。方法回顾性分析2003年11月至2013年2月期间经本院确诊为SLE的559例住院患者(男60例,女499例),将其分为心律失常组和非心律失常组,收集各项检查检验指标,采用多因素分析SLE并发心律失常的独立危险因素。结果 559例SLE患者中有142例(25.4%)并发心律失常。其中以窦性心动过速所占比例最高(56.34%),其次为窦性心动过缓(16.9%),再其次为I度房室传导阻滞和室性早搏(均为6.34%),其余为其他心律失常(0.7%～3.5%)。单因素分析显示,SLE患者合并心律失常的危险因素有合并多系统损害、其他结缔组织病、心包积液、左房扩大、高甘油三酯、高血糖、低高密度脂蛋白、低血浆白蛋白、低钙血症、高C反应蛋白、抗Sm阳性及抗RNP阳性(P<0.05)。多因素分析显示,独立危险因素有抗RNP阳性、左房扩大及低血浆白蛋白(P<0.05)。结论 SLE患者可并发各种类型心律失常,其中以窦性心动过速最为常见;独立危险因素有抗RNP阳性、左房扩大及低血浆白蛋白。

Objective To investigate types and risk factors of cardiac arrhythmias in patients with systemic lupus ery- thematosus （SLE）. Methods A total of 559 inpatients （ male 60, median = 21 ） with SLE from our hospital varying from November 2003 to February 2013 were divided into arrhythmias group and non-arrhythmias group. Tile following data were collected at the time of registration： general information, electrocardiogram, echocardiography, lupus and immune markers, biochemical results. The independent risk factors of cardiac arrhythmias secondary to SLE were investigated by multiple fac- tor analysis. Results There were 142 cases （25.4%） with cardiac arrhythmias in 559 inpatients. The type with the biggest percentage of cardiac arrhythmias in our study was sinus tachycardia （56.34%）, the next one was sinus bradycar- dia （ 16.9% ） , followed by I degree atrioventricular block and ventricular premature beats （ both were 6.34% ）, the rest were other types （0.7 % -3.5 % ）. Univariate analysis showed that cardiac arrhythmias in patients with SLE were associat- ed with multiple system dysfunction, existence of other connective tissue disease, pericardial effusion, left atrial enlarge- ment, high glycerine, high blood glucose, low HDL cholesterol, hypoalbuminemia, hypocalcemia, high C reactive protein, positive anti-Sm and positive anti-RNP（ P〈0.05 ）. Binary logistic regression analysis demonstrated that cardiac arrhythmias were independently associated with positive anti-RNP, left atrial enlargement and hypoalbuminemia （P〈O. 01 or 0.05 ）. Conclusions SLE patients can coexist with various types of cardiac arrhythmias. The independent risk factors associated with cardiac arrhythmias secondary to SLE include positive anti-RNP, left atrial enlargement and hypoalbuminemia.