系统性红斑狼疮心脏受累患者临床特征及免疫抑制干预对并发全心脏扩大者的效果

Clinical characteristics and therapeutic efficacy of immunosuppressive therapy on lupus erythematosus patients complicated with heart enlarged

摘要:

目的 总结心脏受累系统性红斑狼疮（SLE）患者临床特征，分析该类患者临床特点及免疫抑制治疗后的预后。方法 回顾性分析2010年1月—2017年1月新疆医科大学第一附属医院风湿免疫科诊治的902例SLE患者临床资料。结果 902例患者中，532例无心脏损害，370例出现心脏损害。370例心脏损害患者中，男性45例，女性325例。男女间比较，心悸、胸痛、胸闷表现差异有统计学意义（P?<0.05）；心电图方面，T波改变、房室传导阻滞、PR间期延长差异有统计学意义（P?<0.05）；心脏超声（UCG）中，少量、中量的心包积液差异有统计学意义（P?<0.05）；有无心脏损害两者间比较，贫血、肾脏病变比例差异有统计学意义（P?<0.05）。有心脏损害患者的补体C3、高密度脂蛋白低于无心脏损害者（P?<0.05），而起病至免疫抑制剂治疗前的时间大于无心脏损害者（P?<0.05）。有无全心扩大两者间比较，贫血、肾脏病变比例差异有统计学意义（P?<0.05），全心扩大组贫血、肾脏病变比例高于无全心扩大组。全心扩大组左心室射血分数（LVEF）低于无全心扩大组（P?< 0.05），病程、起病至免疫抑制剂治疗前的时间、左心室舒张末期内径（LVEDD）大于无全心扩大组（P?<0.05）。心脏扩大7例患者UCG指标治疗前后水平差异有统计学意义（P?<0.05）。结论 SLE患者心脏损害较为常见，全心脏扩大者早期免疫干预治疗对保护心脏有益。免疫抑制治疗对心脏扩大SLE患者心脏结构及功能的变化有改善。

Abstract:

Objective To summarize the clinical characteristics of systemic lupus erythematosus (SLE) patients with cardiac involvement and therapeutic efficacy of immunosuppression on cardiac enlargement. Methods The clinical data of 902 patients with SLE who were admitted into our hospital from January 2010 to January 2017 were retrospectively analyzed. Results Among the 902 patients enrolled in the study, 45 males and 325 females were complicated with cardiac enlargement. The severity of myocardial disease in SLE was correlated with the severity. There were statistically significant differences in symptoms (palpitations, chest pain, and chest tightness), electrocardiogram (T wave changes, atrioventricular block, and PR interval extension), UCG (small and medium amount of pericardial effusion), anemia, renal lesions, complement, and high-density lipoprotein between two groups (P?