应用美国超声心动图学会推荐的指标评价系统性红斑狼疮对右心功能的影响  

Effect of systemic lupus erythematosus on right heart function evaluated by parameters recommended by the American Society of Echocardiography

作　　者：赵航[1] 沈学东[1] 宋秀兰[1] 乔志卿[1] 徐婷嬿[1] 沈节艳[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,200127

出　　处：《中华超声影像学杂志》2013年第3期199-203,共5页Chinese Journal of Ultrasonography

摘　　要：目的应用美国超声心动图学会（ASE）指南推荐的右心功能指标评价系统性红斑狼疮（SLE）存在和不存在肺动脉高压时的表现，探讨反映患者右心功能减退最敏感的指标，并分析其与肺动脉压和肺血管阻力的关系。方法研究对象为SLE患者43例，按照肺动脉收缩压的高低分为二组：SLE无肺动脉高压组24例（肺动脉收缩压≤35mmHg）；SLE合并肺动脉高压组19例（肺动脉收缩压〉35millHg）。正常对照组22例。三组患者间年龄及性别构成均无显著性差异。对所有患者测定26项右心功能超声指标，比较各组间指标的差别，分析肺动脉压和肺血管阻力对右心功能的影响。结果单因素方差分析显示，三组间比较有17项指标差异有统计学意义（P〈0．05）。其中三尖瓣收缩期位移和三尖瓣血流E／A比值在SLE无肺动脉高压组已经较正常组降低（P=0．04和0．03）。有11项指标能反映SLE合并或不合并肺动脉高压的差别（P〈0．05）。多元Logistic回归分析示肺血管阻力升高者右心功能减退的可能性较肺血管阻力正常者高出6倍以上（oddsratio=6．18，P=0．02）。结论SLE患者右室功能受损的程度同肺血管阻力及肺动脉收缩压升高的程度相关。肺血管阻力升高是右心功能受损的重要预测因子。Objective To evaluate the right heart dysfunction in SLE patients with/ without pulmonary arterial hypertension （PAH） using the parameters recommended by the American Society of Echocardiography （ASE）,and to examine whether the right heart dysfunction is directly related to elevated pulmonary arterial systoli.c pressure （PASP） and pulmonary vascular resistance （PVR）. Methods Study population composited of 43 patients with SLE. The patients were divided into two groups according to the PASP measured by echocardiography： Group A was 24 patients with PASP 435 mm Hg, Group B was 19patients with PASP≤35 mm Hg. Twenty-two healthy subjects with age and gender matched were set as control group. Routine transthoracic echocardiography study was performed on all patients and 26 parameters were measured in order to compare the differences of the parameters among the three groups. Results There were significant differences in 17 parameters among the three groups （ P 〈0.05）. Tricuspid annular plane systolic excurtion（TAPSE） and E/A ratio of tricuspid flow velocities in SLE patients without PAH significantly decreased compared to control group （ P = 0.04 and 0.03）. There were significant differences in 11 parameters between SLE with and without PAH group （ P 〈0.05）. Multivariate logistic regression analysis indicated that after adjustment for age and gender, the patients with elevated PVR associated with a 6.18-fold increase in right ventricular dysfunction compared to the patients with normal PVR （ P = 0.02）. Conclusions The impairment of right ventricular function in SLE patients was directly related to PVR and PASP. Elevation of PVR was an important predictor for right heart dysfunction.

关 键 词：超声心动描记术 红斑狼疮 系统性 心室功能 右 心房功能 右 高血压 肺性 

分 类 号：R54[医药卫生—心血管疾病] R593[医药卫生—内科学]