基于ECTA队列的大动脉炎患者心脏受累横断面调查

A cross-sectional survey of Takayasu’s arteritis patients with cardiac involvements in East China Takayasu’s Arteritis cohort

目的总结华东地区大动脉炎(East China Takayasu’s Arteritis,ECTA)队列大动脉炎(Takayasu’s arteritis,TAK)患者的心脏受累特征。方法纳入2009年1月至2019年12月复旦大学附属中山医院ECTA队列TAK患者,所有患者均符合1990年美国风湿病学会TAK分类标准,排除具有病毒性心肌炎、风湿性心脏病或先天性心脏病病史的TAK患者。将上述患者分为心脏受累组和无心脏受累组,分析心脏受累特点并比较两组临床资料。结果共纳入TAK患者390例,其中心脏受累组186例(47.7%)。TAK患者中心脏瓣膜病155例(39.7%),冠脉受累52例(13.3%),肺动脉高压51例(13.1%),高血压性心脏病17例(4.4%),心肌病7例(1.8%)。心脏受累组男女比例为1∶5.6,初发中位年龄为32.6(23.3~45.4)岁,中位病程为30.0(6.4~108.5)个月。心脏受累组患者更易出现胸闷、胸痛、气促等表现(P<0.05),氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)水平也高于无心脏受累组(P<0.001)。Ⅱb型TAK患者更容易出现心脏受累。结论TAK心脏受累并不少见,ECTA队列中心脏受累的患者约47.7%,以瓣膜病、冠脉受累多见,建议规律随访以便早期发现心脏受累的高危患者。

Objective To investigate the characteristics of Takayasu’s arteritis(TAK)patients with cardiac involvements in East China Takayasu’s arteritis(ECTA)cohort.Methods TAK patients were recruited from Zhongshan Hospital in ECTA cohort from Jan 2009 to Dec 2019.All patients met the 1990 TAK classification criteria of the American College of Rheumatology,except for viral myocarditis,rheumatic heart disease,or congenital heart disease.Patients were divided into cardiac involvement and noncardiac involvement group.Clinical characteristics were analyzed and compared between the two groups.Results A total of 390 TAK patients were recruited in our study,of which 186 patients(47.7%)had cardiac involvements.There were 155 cases(39.7%)with heart valve disease,52 cases(13.3%)with coronary artery involvement,17 cases(4.4%)with hypertensive heart disease,7 cases(1.8%)with cardiomyopathy,and 51 cases(13.1%)with pulmonary hypertension.In cardiac involvement group,the male/female ratio was 1∶5.6,the median onset age was 32.6(23.3-45.4)years,and median disease duration was 30.0(6.4-108.5)months.More TAK patients with cardiac involvements complained of having symptoms than those without cardiac involvements,such as chest distress,tachycardia and anhelations(P<0.05),and their N terminal pro B type natriuretic peptide(NT-pro BNP)were higher as well(P<0.001).TypeⅡb TAK patients were more likely to have cardiac impairments.Conclusion Cardiac involvements were not rare in TAK patients.There were 47.7%of patients with cardiac involvement in the ECTA cohort,especially valvular disease and coronary artery involvement.Regular follow-up is recommended for early detection of cardiac involvements in TAK patients.