系统性红斑狼疮患者心脏瓣膜病变的超声心动图特征及危险因素分析  

Echocardiographic Feature and Clinical Risk Factors of Systemic Lupus Erythematosus Patients With Valvular Heart Disease

作　　者：廖书生[1] 叶腾[1] 倪显达[1] 屠鸿翔[2] 贾志军[1] LIAO Shusheng;YE Teng;NI Xianda;TU Hongxiang;JIA Zhijun(Department of Ultrasound,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou(325000),Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院超声影像科,浙江省温州市325000 [2]温州医科大学附属第一医院检验科,浙江省温州市325000

出　　处：《中国循环杂志》2022年第7期695-700,共6页Chinese Circulation Journal

基　　金：温州市基础性医疗卫生科技项目(Y20211050)。

摘　　要：目的:通过分析系统性红斑狼疮(SLE)患者的临床资料和心脏瓣膜病变的超声心动图特征,探讨SLE患者出现心脏瓣膜病变的危险因素。方法:回顾性分析2005年1月至2020年12月在我院住院治疗的104例SLE患者的临床资料和超声心动图结果,根据有无心脏瓣膜病变分为瓣膜病变组(n=36)和无瓣膜病变组(n=68)。采用单因素和多因素Logistic回归分析评估SLE患者出现心脏瓣膜病变的危险因素。结果:36例(34.6%)患者有心脏瓣膜病变,表现形式多样:瓣膜增厚伴反流18例(50.0%),Libman-Sacks赘生物13例(36.1%),瓣膜增厚伴狭窄5例(13.9%)。瓣膜病变组患者的病程明显长于无瓣膜病变组[(8.4±6.2)年vs.(5.5±5.6)年,P=0.02],D-二聚体水平[(4.4±0.5)mg/L vs.(1.4±1.2)mg/L,P=0.02]、C反应蛋白水平[(16.6±7.3)mg/L vs.(6.1±3.6)mg/L,P=0.02]、狼疮抗凝物阳性比例(41.7%vs. 14.7%,P<0.01)、3个抗体(狼疮抗凝物、抗心磷脂抗体、抗β2糖蛋白1抗体)阳性比例(13.9%vs. 2.9%,P=0.03)均明显高于无瓣膜病变组。多因素Logistic回归分析显示,C反应蛋白升高(OR=1.16,95%CI:1.02-1.30,P=0.02)、狼疮抗凝物阳性(OR=8.00,95%CI:2.15-29.15,P<0.01)、3个抗体阳性(OR=5.61,95%CI:1.03-30.59,P<0.01)是SLE患者出现心脏瓣膜病变的独立危险因素。结论:超声心动图是评价SLE患者心脏瓣膜病变的有效手段。C反应蛋白升高、狼疮抗凝物阳性和3个抗体阳性是SLE患者出现心脏瓣膜病变的高危因素。Objectives: This study aimed to investigate the echocardiographic feature and clinical risk factors in patients with systemic lupus erythematosus(SLE) and valvular heart disease.Methods: A total of 104 patients with SLE, who were admitted to our hospital from January 2005 to December 2020,were enrolled in this study. Clinical manifestations, laboratory indicators and echocardiographic characteristics were retrospectively analyzed. According to echocardiographic result, the patients were subdivided into valvular heart disease group(n=36) and non-valvular heart disease group(n=68). Bivariate statistical analysis and logistic regression analysis were performed to identify risk factors of valvular heart disease.Results: Valvular heart disease was detected in 36(34.6%) patients. Echocardiographic features varied significantly in these patients. Eighteen(50.0%) patients had valvular thickening with regurgitation, Libman-Sacks vegetations were found in thirteen(36.1%) patients, and valvular thickening with stenosis were found in five(13.9%) patients. Compared with patients in non-valvular heart disease group, patients with valvular heart disease had longer disease duration([5.5±5.6] years vs. [8.4±6.2]years, P=0.02) and higher levels on D-dimer([1.4±1.2] mg/L vs. [4.4±0.5] mg/L, P=0.02), C-reactive protein(CRP)([6.1±3.6]mg/L vs. [16.6±7.3] mg/L, P=0.02), higher rate of positive lupus anticoagulant(14.7% vs. 41.7%, P<0.01), and triple positive rate of antibodies(2.9% vs. 13.9%, P=0.03). Multivariate logistic regression analysis showed that higher CRP level(OR=1.16, 95%CI:1.02-1.30, P=0.02), positive lupus anticoagulant(OR=8.00, 95%CI: 2.15-29.15, P<0.01) and triple positive of antibodies(OR=5.61,95%CI: 1.03-30.59, P<0.01) were independent predictors of valvular heart disease among SLE patients.Conclusions: Echocardiography is a useful tool for identifying valvular heart disease in patients with SLE. Higher CRP level, positive lupus anticoagulant and triple positive of antibodies are the independent predictors of va

关 键 词：系统性红斑狼疮 抗磷脂抗体 Libman-Sacks心内膜炎 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]