系统性红斑狼疮合并心脏损害的相关危险因素分析

Analysis of risk factors of systemic lupus erythematosus complicated with cardiac damage

目的分析合并心脏损害的系统性红斑狼疮(SLE)患者的临床特征并探讨SLE患者出现心脏损害的相关危险因素。方法本研究共纳入169例SLE患者,根据超声心动图检查评估的心脏损害情况将患者分为心脏损害组(n=78)和非心脏损害组(n=91)。采用二元Logistic回归分析探讨SLE患者心脏损伤的危险因素。结果心脏损害组系统性红斑狼疮活动指数(SLEDAI)评分、尿蛋白、甘油三酯、肌酐、尿酸指标水平较非心脏损害组高,红细胞计数及补体C3水平较非心脏损害组低,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,SLEDAI评分(OR=1.136,P<0.05,95%CI:1.024~1.26)、雷诺现象(OR=0.422,P<0.05,95%CI:0.182~0.977)与SLE患者的心脏损害显著相关。心脏损害组SLEDAI评分≥10分的患者光过敏、雷诺症状及肾炎发生率高于SLEDAI评分<10分的患者,差异有统计学意义(P<0.05)。2组双股脱氧核糖核酸(dsDNA)抗体,抗C1q抗体效价,甘油三酯及补体C3、C4指标水平比较,差异有统计学意义(P<0.05)。结论SLE患者发生心脏损害风险显著增加,SLEDAI评分、尿蛋白、甘油三酯、肌酐、尿酸、红细胞计数及补体C3可以作为SLE合并心脏损害的危险因素。合并有雷诺现象和疾病高度活动期的患者应尽早行心脏超声及心电图检查,综合评估后决定是否启动预防策略。

Objective To analyze the clinical characteristics of patients with systemic lupus erythematosus(SLE)with heart damage and to explore the risk factors for heart damage in SLE patients.Methods A total of 169 patients with SLE were enrolled in this study.According to echocardiography,the patients were divided into two groups:heart damage group(n=78)and non-damage group(n=91).Binary Logistic regression analysis was used to explore the risk factors of cardiac injury in patients with SLE.Results The score of systemic lupus erythematosus activity index(SLEDAI),the levels of urinary protein,triglyceride,creatinine and uric acid in the heart damage group were higher than those in the non-heart damage group,while the red blood cell count and the level of complement C3 in the heart damage group were lower than those in the non-heart damage group(P<0.05).Multivariate Logistic regression analysis showed that SLEDAI score(OR=1.136,P<0.05,95%CI,1.024 to 1.260)and Raynaud phenomenon(OR=0.422,P<0.05,95%CI,0.182 to 0.977)were significantly correlated with heart damage in SLE patients.The incidence rates of photosensitivity,Raynaud′s symptom and nephritis in the patients with SLEDAI score≥10 were higher than those with SLEDAI score<10(P<0.05).There were significant differences in double-stranded DNA(dsDNA)antibody,anti-C1 q antibody titer,triglyceride and complement C3 and C4 between the two groups.Conclusion The risk of heart damage is significantly increased in patients with SLE.SLEDAI score,urinary protein,triglyceride,creatinine,uric acid,red blood cell count and complement C3 can be used as risk factors for heart damage in patients with SLE.Patients with Raynaud′s phenomenon and highly active disease should be examined by echocardiography and electrocardiogram as soon as possible,and the prevention strategy should be started after comprehensive evaluation.