系统性硬化病合并心脏受累的临床特点及预测因素  

Clinical characteristics and predictive factors of systemic sclerosis associated heart disease

作　　者：刘冰冰 张瑾[1] 俞秋霞 顾奕 范丽怡 俞天航 王晓东[1] 刘伟丽[1] 陈露 关海旺 Liu Bingbing;Zhang Jin;Yu Qiuxia;Gu Yi;Fan Liyi;Yu Tianhang;Wang Xiaodong;Liu Weili;Chen Lu;Guan Haiwang(Department of Rheumatology and Immunology,Ningbo Medical Center Lihuili Hospital,Lihuili Hospital of Ningbo University,Ningbo 315040,China;Ningbo Medical Center Lihuili Hospital,Ningbo Institute of Innovation for Combined Medicine and Engineering,Ningbo 315103,China;Medical School of Ningbo University Clinical Medicine,Ningbo 315211,China;Cardiovascular Medicine,Ningbo Medical Center Lihuili Hospital,Lihuili Hospital of Ningbo University,Ningbo 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院、宁波大学附属李惠利医院风湿免疫科,宁波315040 [2]宁波市医疗中心李惠利医院、宁波市医工(军民)融合创新研究院,宁波315103 [3]宁波大学医学院临床医学院,宁波315211 [4]宁波市医疗中心李惠利医院、宁波大学附属李惠利医院心血管内科,宁波315040

出　　处：《中华风湿病学杂志》2023年第11期733-739,I0004,共8页Chinese Journal of Rheumatology

基　　金：浙江省医药卫生科技计划基金(2018KY158);宁波市自然科学基金(2018A610250)。

摘　　要：目的分析SSc合并心脏受累的临床特点及预测因素。方法收集2016年1月至2021年12月宁波市医疗中心李惠利医院明确诊断的SSc患者临床资料,根据是否合并心脏受累分为阳性组和阴性组,8名健康对照组来自体检中心。采用t检验、秩和检验或χ^(2)检验比较2组患者及健康对照组的临床特征,Logistic回归及ROC曲线分析SSc合并心脏受累的危险因素。同时利用转录组测序分析2组患者及健康对照组差异基因表达。结果①共纳入75例SSc患者,剔除其中6例重叠综合征和1例合并先天性心脏病患者,分析68例患者临床资料发现:合并心脏受累者(阳性组)16例(23.5%),未合并心脏受累者(阴性组)52例(76.5%),16例心脏受累患者中出现心电图异常12例(75.0%),心脏瓣膜病变9例(56.2%),心脏结构异常8例(50.0%),生物标志物升高10例(83.3%),心包积液8例(50.0%)。②2组相比,阳性组病程更长[120(11.2,132)个月与48(24,90)个月,Z=-2.08,P=0.037)],阳性组肺动脉高压(PAH)(50.0%与11.5%,χ^(2)=11.07,P<0.001)和肾功能不全(50.0%与3.8%,χ^(2)=20.78,P<0.001)的发生率明显高于阴性组。进一步Logistic多因素回归分析证明,长病程[OR值(95%CI)=1.011(1.001,1.021),P=0.031]、PAH[OR值(95%CI)=5.431(1.065,27.710),P=0.042]、肾功能不全[OR值(95%CI)=30.444(4.139,223.938),P<0.001]是SSc合并心脏受累的独立危险因素。③68例SSc患者中共63例完成了甲襞微循环(NVC)检查,发现2组异常NVC改变差异具有统计学意义(93.3%与58.3%,χ^(2)=5.87,P=0.013);阳性组毛细血管总数明显少于阴性组[3.5(2,4.8)与6(5,7),Z=-2.97,P=0.003];进一步行ROC曲线分析得出,毛细血管总数<4.5预测心脏受累的发生(灵敏度为80.0%,特异度83.8%),ROC曲线下面积95%CI为0.805(0.061,1.000),P=0.003。④共11例SSc患者(阳性组6例,阴性组5例)和8名健康对照组行转录组测序,最后筛选得到同步下调基因TNFRSF13B,3组间差异有统计学意义(χ^(2)=11.88,P=0.003),且在阳性组�Objective To analyze the clinical characteristics and predictive factors of SSc associated heart disease.Methods The clinical data of patients with SSc from January 2016 to December 2021 in Ningbo Medical Center Lihuili Hospital were collected.Aight healthy controls come from the medicial examination center.They were divided into a positive group and a negative group based on whether heart involvement was present or not.The clinical manifestations of the two groups were compared by t test,Wilcoxon signed rank test andχ^(2) test and Logistic regression or ROC curve was used to analyze the prognostic risk of SSc associated heart disease.Then the transcriptome sequencing was used to analyze the differential gene expression.Results①A total of 75 SSc patients were treated in our hospital,of which 6 patients with overlap syndrome and 1 patient with congenital heart disease were excluded.The clinical data of 68 patients were analyzed including 16 patients in the positive group and 52 patients in the negative group.Among the 16 patients with cardiac involvement,12 patients(75.0%)had abnormal electrocardiogram,9 patients(56.2%)with heart valve disease,8 patients(50.0%)with abnormal cardiac structure and 8 patients(50.0%)with pericardial effusion.The biomarkers were elevated in 10 cases(83.3%).②Univariate analysis showed that the positive group had a longer course of disease[120(11.2,132)months vs 48(24,90)months,Z=-2.08,P=0.037],and the rate of pulmonary arterial hypertension(50.0%vs 11.5%,χ^(2)=11.07,P<0.001)and renal insufficiency(50.0%vs 3.8%,χ^(2)=20.78,P<0.001)in the positive group were significantly higher than those in the negative group.Further Logistic regression analysis revealed that long course of disease[OR(95%CI)=1.011(1.001,1.021),P=0.031],pulmonary arterial hypertension[OR(95%CI)=5.431,95%CI(1.065,27.710),P=0.042]and renal insufficiency[OR(95%CI)=30.444(4.139,223.938),P<0.001]were risk factors for SSc associated heart disease.③Nail-fold videocapillaroscopy(NVC)was checked in 63 patients.The differ

关 键 词：硬皮病 系统性 心脏 肺动脉高压 肾功能不全 ROC曲线 

分 类 号：R593.2[医药卫生—内科学] R54[医药卫生—临床医学]