系统性红斑狼疮诱发的非感染性心内膜炎心脏瓣膜病变的超声及临床特点分析

The ultrasonographic and clinical characteristics of valve disorders in patients with non-infective endocarditis due to systemic lupus erythematosus

目的对比分析超声心动图对非感染性心内膜炎（NIE）与不典型感染性心内膜炎（IE）的诊断价值,提高对NIE尤其是系统性红斑狼疮（SLE）诱发的NIE心脏瓣膜病变的超声及临床特点认识。方法收集2005年7月至2015年1月首都医科大学附属北京朝阳医院收治的经临床确诊的NIE患者38例,其中SLE患者10例,风湿性心脏病10例,类风湿心脏病患者11例,乙肝相关患者7例;同时以该院同期收治的经临床确诊的不典型IE患者42例作为对照。采用χ2检验比较两组患者血培养、心电图、血清免疫学、超声心动图检查结果的差异。结果两组患者血培养、血清免疫学、心电图检查结果差异均有统计学意义（χ2值分别为26.29、5.53、4.80,P值均〈0.05）,但超声心动图检查结果差异无统计学意义（χ2=0.03,P〉0.05）。38例NIE患者中,27例患者超声心动图检出赘生物,检出率为71.1%;11例患者超声心动图呈瓣叶增厚;赘生物直径为2~7 mm。42例不典型IE患者中,36例患者超声检出赘生物,检出率为85.7%（36/42）;6例患者超声心动图呈瓣叶增厚;赘生物直径为2~19 mm,其中左心赘生物28例,右心赘生物8例。病例组中2例SLE患者经胸超声心动图检查结果为阴性,经食管超声心动图显示阳性结果确诊;9例合并轻度以上瓣膜反流;10例SLE瓣膜病变者经临床采用激素联合环磷酰胺治疗后狼疮病情稳定;患者最短于治疗后5 d、最长3年超声心动图复查,增厚的瓣膜较前明显缩小至消失。结论超声心动图可以早期快速发现SLE诱发的NIE瓣膜受累时特征性的非感染性血栓性疣状赘生物。超声心动图可为不典型IE及NIE的后续治疗及疗效观察提供有价值的参考。

Objective To enhance understanding on echocardiographic and clinical characteristics of valve lesions of non-infective endocarditis（NIE）, particularly in patients with systemic lupus erythematosus（SLE）. Comparative analysis of the diagnostic value of echocardiography was performed in patients with non-infective endocarditis and atypical infective endocarditis（IE）. Methods Data from 38 patients with clinically diagnosed NIE in the institution were collected retrospectively during July 2005 and January 2015, including 10 patients with SLE, 10 with rheumatic heart disease, 11 with rheumatoid arthritis, and 7 with hepatitis B. Data of 42 patients diagnosed as atypical IE during the same period were collected as control group. All patients underwent examinations of blood culture, sero-immunological tests, electrocardiogram and echocardiography. Comparison was made between the two groups using SPSS 11.5 software package. Results The difference in blood culture, sero-immunological tests and electrocardiogram was statistically significant between the groups（χ~2 value, 26.29, 5.53, and 4.80, respectively, all P〈0.05）, although there was no statistical difference in results of echocardiography（χ~2=0.03, P〈0.05）. Echocardiography identified valvular vegetations in 27 of 38 patients, with NIE with a detection rate of 71.0%; The size of the vegetations ranged from 2 to 7 mm in diameter; Valve vegetations was found in 36 of 42 patients with atypical IE, with a detection rate of 85.7%; the other six cases demonstrated valvular thickening only; in this group, the vegetations ranged from 2 mm to 19 mm in size and were located in the left heart in 28 patients, 8 cases in the right heart. In the case group, two cases of valve lesions in patients with SLE were confirmed by transesophageal echocardiography（TEE）, while missed on TEE examination. Nine cases with more than mild valve regurgitation were identified. Ten cases were treated with hormones and cyclophosphamide, after which valve lesions resolution was found on serial echocardiography tests with a follow-up period of 5 days to 3 years. Conclusions Echocardiography is capable of detecting valve lesions at early stage in patients with NIE, particularly in patients with SLE. Echocardiography plays a crucial role in identifying the non-infective thrombotic vegetations, guiding clinical treatment and monitoring the therapeutic effects.