系统性红斑狼疮心脏超声特点及肺高压危险因素分析

Echocardiographic features and predictors of pulmonary hypertension in patients with systemic lupus erythematosus

目的探讨SLE超声心动图特点及SLE并发肺高压（SLE-PH）的危险因素。方法总结598例SLE患者的超声心动图表现，对107例疑诊SLE—PH[超声心动图估测肺动脉收缩压（PASP）≥140mmHg]和64例疑诊中重度PH（PASP≥50mmHg）患者的临床特点进行回顾性分析。采用t检验、X^2检验及Logistic回归模型进行统计学分析。结果423例（70．7％）患者超声心动图异常，表现为心包积液272例（45．5％）、瓣膜关闭不全187例（31．3％）、疑诊PH107例（17．9％）、左心室增大35例（5．9％）、左心室肥厚26例（4．3％）、右心室增大39例（6．5％）、左心室射血分数（LVEF）＜50％36例（6．0％）、右心室收缩功能减低13例（2．2％）等。Logistic回归分析显示雷诺现象（OR=3．205，95％CI：1．911～5．375，P=0．000）、血小板减低（OR=1．680，95％CI：1．049。2．689，P=0．031）、高尿酸血症（OR=3．643，95％CI：2．154～6．164，P=0．000）及抗U1．RNP抗体阳性（OR=1．777，95％C1：1．099～2．874，P=0．019）是疑诊SLE—PH的独立危险因素，发热（OR=0．576，P=0．029）、皮疹（OR=0．558，P=0．017）则是疑诊SLE．PH的独立保护因素；病程（OR=1．145，95％CI：1．016～1．290，P=-0，026）和雷诺现象（OR=3，371，95％CI：1．126～10．086，P=0．030）是疑诊中重度PH的独立危险因素，肾病综合征（OR=0．042，P=0．009）则是疑诊中重度PH的独立保护因素。结论SLE患者普遍存在心脏受累，并发PH者不少见。临床上伴有血小板减少、抗U1-RNP抗体阳性、高尿酸血症尤其是伴发雷诺现象的SLE患者应注意筛查PH，早期诊断，早期治疗。

Objective To analyze the risk factors of pulmonary hypertension in patients with systemic lupus erythematosus （SLE-PH）. Methods Echo data of 598 SLE patients were collected, clinical characteristics of 107 suspected SLE-PH （PASP 〉140 mmHg, estimated by Echo） and 64 suspected moderate to severe PH （PASP 〉50 mmHg） were retrospectively analyzed. T-test, X^2-test and Logistic regression were used for statistical analysis. Results Out of 598 patients 70.7%（423 patients） had abnormal Echo findings, and pericardial effusion in 45.5%（272 cases）, valvular insufficiency in 31.3%（187 cases）, suspected PH in 17.9%（107 cases）, left ventricular enlargement in 5.9%（35 cases）, left ventricular hypertrophy in 4.3%（26 cases）. In addition 1.7% had mitral valve prolapse, 1.5% had mitral valve vegetation, and right ventricular enlargement in 6.5%（39 cases）, LVEF〈50% in 6.0%（36 cases）, right ventricular systolic dysfunction in 2.2%（13 cases）. Logistic regression analysis showed Raynaud＇s phenomenon （OR=3.205, 95%CI： 1.911- 5.375, P=0.000）, thrombocytopenia （OR=1.680, 95%CI： 1.049-2.689, P=0.031）, hyperuricemia （OR= 3.643, 95%CI： 2.154-6.164, P=0.000）, and anti-U1RNP antibody positivity （OR=l.777, 95%CI： 1.099- 2.874, P=0.019） were independent risk factors for suspected SLE-PH, fever （OR=0.576, P=0.029） and rash （OR=0.558, P=0.017） were independent protective factors for suspected SLE-PH. SLE duration （OR=1.145, 95%（7/： 1.016-1.290, P=0.026） and Raynaud＇s phenomenon （OR=3.371, 95%CI： 1.126-10.086, P=0.030）were independent risk faetors for suspected moderate to severe PH, nephritic syndrome （0R=0.042, P=0.009） was the in dependent protective factor for suspected moderate to severe PH. Conclusion Cardiac involvement is common in SLE patients. Screening for PH should be considered in SLE patients with thrombocytopenia, hyperuricemia, anti-U 1RNP antibody positivity, particularly with Raynaud＇s phenomenon.