大动脉炎并发心肌损害的临床特征分析

Myocardial involvement in patients with Takayasu arteritis

目的 通过对大动脉炎合并心肌受累的临床特征分析,提高对该病的认识.方法 回顾性分析北京协和医院1987-2013年收治的大动脉炎患者病历资料,从中筛选出大动脉炎出现心肌损害者进行分析.结果 86例大动脉炎合并心脏损害者中,23例患者出现心肌损害,心力衰竭发生率65％（15/23）,15例患者冠状动脉CT血管造影正常,65％（15/23）患者有血压轻至中度升高,74％（17/23）患者存在肺动脉高压.治疗前左心室射血分数为（34.70±0.09）％,激素免疫治疗后为（40.20±1.23）％,治疗前后差异有统计学意义（t=4.302,P=0.02）.结论 大动脉炎心肌受累并不少见,是独立危险因素,影响患者预后,早发现和积极治疗能改善患者预后.

Objective To investigate the clinical characteristics and related pathogenetic factors in Takayasu arteritis with myocardial involvement.Methods We retrospectively analyzed clinical data of Takayasu arteritis patients with myocardial involvement of Peking Union Medical College Hospital from 1987 to 2013.Results Myocardial involvement was diagnosed in 23 patients from 86 Takayasu arteritis patients.Sixty-five percent （15/23） of patients presented with congestive heart failure.Fifteen patients were without coronary artery involvement.Sixty-five percent （15/23） of patients with mild to moderate hypertension.Seventyfour percent（17/23） patients had pulmonary hypertension.Left ventricular ejection fraction was （34.70 ±0.09）%.Glucocorticco costeroid and immunosuppressive therapy could significantly increase left ventricular ejection fraction （t=4.302,P〈0.05）.Conclusion We emphasize that myocardial involvement is common in Takayasu arteritis.It is an independent risk factor that impacts the prognosis.Early detection of myocardial involvement and effective therapy can improve the prognosis.