系统性红斑狼疮肺动脉高压相关危险因素分析

Analysis of the relative risk factors between systemic lupus erythematosus and pulmonary artery hypertension

目的了解系统性红斑狼疮合并肺动脉高压(SLEPAH)的临床及实验室特点,分析其相关危险因素,以提高对SLE-PAH的认识。方法对358例SLE患者进行心脏彩超肺动脉压力检测,将是否合并PAH及肺动脉压力进行分组、分级,比较各组间差异,详细记录全部患者的临床及实验室资料,分析其相关性。结果 (1)358例患者,无PAH的SLE患者142例(39.7%),有PAH的SLE患者216例(60.3%),无PAH组与有PAH组及轻度PAH组与中重度PAH组间在年龄、性别、病程、SLEDAI方面差异均无统计学意义。(2)有PAH组D-二聚体延长及肾功能异常的发生率高于无PAH组,中重度PAH组(n=65)出现心包炎、肺间质病、雷诺现象、高尿酸血症及APTT延长的发生率明显高于轻度PAH组(n=151)(P<0.05)。其中死亡6例,均为重度PAH患者。(3)Logistic回归分析:D-二聚体延长(OR=1.975,95%CI:1.254~3.109,P=0.003)及肾功能异常(OR=1.930,95%CI:1.038~3.589,P=0.038)是发生PAH的危险因素,心包炎(OR=2.517,95%CI:1.228~4.919,P=0.007)、肺间质病变(OR=2.645,95%CI:1.051~6.652,P=0.039)、高尿酸血症(OR=2.136,95%CI:1.056~4.322,P=0.035)、APTT延长(OR=2.577,95%CI:1.250~5.313,P=0.010)可能是发展为中重度肺动脉高压的危险因素。结论SLE-PAH与狼疮的活动性无明显相关性。SLE合并心包炎、肺间质病变、高尿酸血症、D-二聚体及APTT延长应重视对肺动脉高压监测,D-二聚体延长及肾功能异常可能是肺动脉高压的危险因素。

Objective To investigate the clinical and laboratory characteristics of systemic lupus erythematosus （SLE） complicated with pulmonary hypertension （PAH） and to analyze the relevant risk factors so as to improve the understanding of SLE-PAH. Methods A total of 358 patients with SLE were enrolled in this study. Patients with cardiac ultrasonography were examined for pulmonary hypertension. According to pulmonary artery pressure, patients were divided into different groups. The differences between the groups were compared, detailed records of all patients with clinical and laboratory data, analysis of its relevance. Results ①358 patients, 142 SLE patients without PAH （39.7%）, 216 cases of SLE patients with PAH （60. 3% ）, There were no significant differences in age,sex,course of disease and SLEDAI between the PAH group and the non-PAH group, and so did in mild PAH group and severe PAH group. ②The incidence of D-dimer prolongation and renal dysfunction in PAH group was higher than that of non-PAH group （P 〈 0. 05 ）. The patients with moderate to severe PAH （ n = 65 ） showed peri- carditis, interstitial lung disease, Raynaud＇s phenomenon, hyperuricemia and APTT prolongation was significantly higher in patients with mild pulmonary hypertension （n = 151 ） （P 〈 0. 05 ）. Among them, 6 cases died, all of them were severe PAH patients. ③Logistic regression analysis： D-dimer prolongation （OR = 1. 975,95% CI： 1. 254 -3. 109, P =0. 003） and renal dysfunction （OR = 1. 930,95% CI：1. 038 -3.589,P =0. 038） were risk factors for developing PAH. Pericarditis （OR =2. 517,95% CI： 1. 228 -4. 919, P =0. 007） , interstitial lung disease （ OR = 2. 645,95% CI： 1. 051 - 6. 652, P = 0. 039, hypemrieemia （ OR = 2. 136,95% CI： 1. 056 - 4. 322, P = 0. 035 ） , APTT prolongation （OR = 2. 577,95 % CI：1. 250 -5.313, P = 0. 010） may be a risk factor for developing moderate to severe pulmonary hypertension. Conclusion SLE-PAH was not significantly associated with lupus activity. SLE combined with periearditis, interstitial lung disease, hyperuricemia, D-dimer and APTT prolongation should pay attention to pulmonary hypertension monitoring, D-dimer extension and renal dysfunction may be a risk factor for pulmonary hypertension.