类风湿关节炎患者右心功能超声心动图评估及其与病程、病情的关系

Echocardiographic evaluation of right ventricular function in patients with rheumatoid arthritis and the relationship with illness duration and condition

目的采用超声心动图评估类风湿关节炎(RA)患者右心功能,并分析其与病程、病情的关系。方法选取RA患者70例,按病程分为5年组(病程≤60个月)、10年组(病程61~120个月)各35例,同期体检健康者35例作为对照组。经胸超声心动图测量右心房横径(RA-d1)、右心房长径(RA-d2)、右心房面积(RA-a)及右心室横径(RV-d1),计算右心室面积变化率(FAC),M型超声测量三尖瓣环收缩期位移(TAPSE);TDI模式测量三尖瓣环收缩期峰值速度(TV-S′)、等容收缩时间(IVCT)、射血时间(ET)及等容舒张时间(IVRT),计算右心室作功指数(RMPI);剑下四腔心切面取M型测量右心室前壁厚度(RVAW),测算下腔静脉吸气塌陷率(IVC-CI)等超声心动参数,同时收集患者病程及RA病情指标28关节疾病活动指数(DAS-28)、C反应蛋白(CRP)、类风湿因子(RF)等。结果RA-d1、RVAW三组比较,差异无统计学意义;RA-d2、RA-a、RV-d1对照组<5年组<10年组,IVC-CI、TV-S′、TAPSE、FAC、RMPI对照组>5年组>10年组,差异均有统计学意义(P均<0.05)。相关性分析显示,DAS-28、CRP、RF与右心功能超声心动图指标无相关性,病程与TV-S′、TAPSE、FAC呈负相关(r分别为-0.357、-0.359、-0.396,P均<0.05)而与RMPI呈正相关(r=0.389,P<0.05)。结论RA可引起右心功能损害,且随病程延长加重,与病情无明显相关性;超声心动图定期检查,有助于早期发现及评估RA患者右心功能受损情况。

Objective To investigate the right ventricular function in patients with rheumatoid arthritis(RA)by echocardiography,and its relationship with illness duration and condition.Methods Seventy RA patients were selected as the observation group,and were divided into the 5-year group(duration≤60 months,n=35)and 10-year group(60≤duration≤120 months,n=35)according to the pathography.Meanwhile,35 healthy controls taking physical examination in the same period were selected as the control group.Right atrial transverse diameter(RA-d1),right atrial length diameter(RA-d2),right atrial area(RA-a),right ventricular transverse diameter(RV-d1),and right ventricular area change(FAC)were detected by transthoracic echocardiography(TTE),and M-mode echocardiography were used to measure tricuspid annular systolic displacement(TAPSE),TDI mode was used to measure peak systolic velocity(TV-S')and volume contraction time(IVCT),ejection time(ET)and isovolumic diastolic time(IVRT),then the right myocardial performance index(RMPI)were calculated.Right ventricular anterior wall thickness(RVAW)was measured by M-mode in the apical four-chamber section.Echocardiographic parameters such as inferior vena cava inhalation collapse rate(IVC-CI)were measured.The clinical and biochemical parameters-related to rheumatoid inflammation such as disease duration,disease activity score-28(DAS-28),C-reactive protein(CRP)and rheumatoid factor(RF)were detected.Results No significant difference was found in RA-d1 and RVAW between these three groups;in RA-d2,RA-a,and RV-d1,they were in the following order:the control group<5-year group<10-year group;in IVC-CI,TV-S′,TAPSE,FAC,and RMPI,the control group>5-year group>10-year group,and the difference was significant(all P<0.05).There was no significant correlation between DAS-28,CRP or the parameters of right ventricular function.The disease duration of RA was negatively correlated with TV-S',TAPSE,and FAC(r=-0.357,-0.359,-0.396,all P<0.05),but was positive correlated with RMPI(r=0.389,P<0.05).Conclusions The right ventricular dysfunction can be caused by RA and aggravate with the prolongation of the disease duration.Regular echocardiographic examination is helpful for early detection and evaluation of right ventricular dysfunction.