系统性硬化并发心血管损害临床分析  

Clinical analysis of systemic sclerosis complicated with cardiovascular damage

作　　者：吕婷婷[1] 杨西超[2] 李羽[1] 殷振杰[1] 张岩[1] 

机构地区：[1]第四军医大学唐都医院风湿免疫科,西安710038 [2]第四军医大学西京医院临床免疫科,西安710038

出　　处：《中华实用诊断与治疗杂志》2016年第10期979-981,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81273280);陕西省社发攻关基金(2012K16-12-04)

摘　　要：目的 分析系统性硬化（systemic sclerosis,SSc）患者并发心血管损害（cardiovascular damage,CVD）的临床特点及相关因素。方法 110例SSc患者中,70例（63.6%）并发CVD者为并发CVD组,40例未并发CVD者为单纯SSc组;比较2组临床及实验室指标,观察SSc并发CVD患者的临床特征,分析其相关影响因素。结果 并发CVD组患者发病年龄[（35±9）岁]小于单纯SSc组[（40±8）岁],病程[（6.0±3.3）a]长于单纯SSc组[（4.6±3.6）a],改良Rodnan皮肤硬化评分[（19.7±2.0）分]、血清胱抑素C水平[（1.36±0.17）mg/L]、总胆固醇[（4.9±2.3）mmol/L]、既往使用激素比例[（55±10）%]高于单纯SSc组[（15.9±2.2）分、（1.03±0.09）mg/L、（2.6±1.9）mmol/L、（30±8）%]（P〈0.05）;并发CVD组患者常见损害为高脂血症、稳定性心绞痛和心律失常等,心电图异常以心律失常和心肌供血不足多见,心脏超声异常以心包积液多见;logistic回归分析显示,改良Rodnan皮肤硬化评分（OR=2.301,95%CI：2.066~2.794,P=0.007）、血清C反应蛋白（OR=2.003,95%CI：1.904~2.138,P=0.008）、总胆固醇（OR=1.485,95%CI：1.204~2.201,P=0.007）和胱抑素C（OR=2.001,95%CI：1.990~2.313,P=0.009）水平升高是SSc患者发生CVD的危险因素。结论 CVD为SSc患者常见临床特点;对改良Rodnan皮肤硬化评分、C反应蛋白、总胆固醇和血清胱抑素C水平升高的SSc患者,需高度警惕CVD的发生。Objective To analyze the clinical characteristics and related factors of systemic sclerosis （SSc） complicated with cardiovascular damage （CVD）. Methods In 110 SSc patients, 70 （63.6% ） were complicated with CVD （SSc-CVD group）, and 40 were not complicated with CVD （CVD group）. The clinical and laboratory data were compared to observe the clinical characteristics and analyze the related influencing factors. Results The patients were significantly younger and the disease course was significantly shorter in SSc-CVD group （（35 ± 9）, （6.0± 3.3） years） than those in SSc group （（40±8）, （4.6±3.6） years） （P〈0.05）. Modified Rodnan skin score （mRSS） （19.7±2.0）, cystatin C （（1.36±0.17） mg/L）, total cholesterol （（4.9± 2.3） mmol/L） and percentage of glucocorticoid usage （（55±10）%） in SSc-CVD group were significantly higher than those inSSc group （15.9±2.2, （1. 03±0. 09）mg/L, （2.6±1.9） retool/L, （30±8）%） （P〈0. 05）. In $Sc-CVD group, the common damages included hyperlipidemia, stable angina pectoris and arrhytbmia, arrhythmia and cardiac insufficiency were more common in the abnormal ECG demonstrations, and the echocardiographic abnormality was pericardial effusion. Logistic regression analysis showed high levels of mRSS （OR = 2. 301, 95 0/00 CI： 2. 066 to 2. 794, P=0.007）, C-reactive protein （OR= 2. 003, 95 % C1：1. 904 to 2. 138, P=0.008）, total cholesterol （OR=1. 485, 95%CI： 1. 204 to 2. 201, P=0. 007） and cystatin C （OR=2. 001, 95%CI： 1. 990 to 2. 313, P=0. 009） were the risk factors for SSe-CVD. Conclusion CVD is the common clinical feature in patients with SSc, and elevated levels of mRSS, C-reactive protein, total cholesterol and serum cystatin C are the risk factors for CVD.

关 键 词：系统性硬化 心血管损害 高脂血症 

分 类 号：R593.2[医药卫生—内科学] R54[医药卫生—临床医学]