系统性红斑狼疮心脏损害的临床分析

Clinical analysis of heart lesion associated with lupus erythematosus

目的:探讨系统性红斑狼疮(SLE)心脏损害的发生率、临床类型及相关因素如年龄,性别,病程,临床症状及免疫学指标与心脏损害的关系。方法:回顾分析广东省人民医院的SLE住院患者254例。用SPSS软件LOG IST IC回归法分析有关因素相关性。结果:年龄,性别,病程与心脏损害无关。在254例SLE患者中157例(61.8%)具有心脏损害,其中心电图异常136例(53.5%),心律失常60例(23.6%),瓣膜病45例(17.7%),心包积液38例(15%),房室扩大和/或心肌肥厚27例(10.6%),肺动脉高压24例(9.4%),右心房血栓2例(0.8%)。在有心脏损害组光敏、气促、胸闷痛症状的发生率及血胆固醇含量较无心脏损害组有显著升高(P<0.05)。SLEDA I评分方面在心脏损害与无心脏损害组间也有显著差异(P<0.001)。结论:SLE心脏损害多见,一些临床指标如光敏、气促、胸闷痛症状及血总胆固醇含量等可预示心脏损害的发生,因此重视SLE心脏受累的早期证据及给予适当的降脂治疗,对减少严重心脏损害的发生率是很有意义的。

Objective:Discuss the heart damages′ manifestation in patients with SLE and analyze the relationship between heart damage and related factors such as age,sex,course of this disease,antinuclear antibodies(ANA),anti-double strands DNA(dsDNA),SSA,SSB,anticardiolipin antibodies(ACL),antineutrophil cytoplasmic antibody(ANCA),complement-3,hemoglobin,cholesterol(CHOL),triglyceride(TG),erythrosedimentation(ESR),C-response protein(CRP),24 hours′urine protein quantitation.Methods:The data of 254 SLE patients in GuangDong Province People′s Hospital from March 2003 to June 2005 were retrospectively analyzed.All the patients were consistent with the SLE diagnostic standard formulated by American College of Rheumatology(ACR) in 1977.The data were analyzed using chi-square test,the correlation among related factors were analyzed by Logistic regression.Results:The classification of heart damage′s:There are 157 patients(accounts for 61.8%) with heart damage in 254 SLE patients,including 136 patients(accounts for 53.5%) with abnomal electrocardiograms(ST-T changes),60 patients(accounts for 23.6%) with arrhythmia,45 patients(accounts for 17.7%) with valve defects,38 patients(accounts for 15%) with pericardium effusion,27 patients(accounts for 10.6%) with enlarged atrium/ventricle and/or myocardium thickening,20 patients(accounts for 8%) with pulmonary artery hypertension.There are no significant differences of age,sex,course of disease,rash,arthritis,fever,Renault phenomenon,palpitations,edema,ANA,dsDNA,SSA,SSB,ANCA,ACL,C3,TG,Hb,ESR,CRP,and 24 hours′urine protein between heart damage group and non-heart damage group.But there are significant differences in photosensitive,shortness of breath,uncomfortable in chest,pain symptoms and the level of blood cholesterol between this two groups(P<0.05).There are also marked significant differences in SLEDAI scores between the two groups(t=-3.346,P<0.001).Conclusions:This study indicates that we should pay high attention to look for the evidence of heart involving and to low SLE patients′ cholesterol in order to prevent the heart form damaging,when SLE patient presents the above-mentioned situations.