CAJ | 학술논문

目的总结系统性红斑狼疮( SLE)患者初次发生冠心病的临床特点.方法选自1995年至2010年解放军总医院明确诊断为SLE共3911例患者,其中经冠状动脉造影证实为初发冠心病的共26例,对照组选自2010年解放军总医院收治的经冠状动脉造影证实的初发冠心病患者并排除所有结缔组织性疾病共552例,对各组的传统冠心病危险因素、第一次心血管事件发作时的情况、血生化指标、SLE的活动和治疗情况以及冠状动脉造影结果进行回顾性分析,SLE组按是否以急性冠状动脉综合征(ACS)为首发表现分为ACS亚组(16例)和非ACS亚组(10例),进一步进行组内比较.结果与单纯冠心病组比较,SLE组初发冠心病时年龄较小[(50.4±15.2)岁比(60.6±11.6)岁,P＜0.01],传统危险因素较少[(1.11±1.18)个比(2.50±1.28)个]；而SLE合并早发冠心病亚组(20例)的传统危险因素更少,仅为(0.75±1.02)个,其中13例(65.0％)以ACS为首发表现.SLE并发ACS亚组的激素使用累计时间[24.00(3.75,57.00)个月比1.00(0.00,2.00)个月,P＜0.05]和24h尿蛋白定量[(1.93±1.97)g比(0.76±0.75)g,P＜0.05]明显高于SLE非ACS亚组.冠状动脉造影结果显示SLE合并冠心病组仍以动脉粥样硬化狭窄为主要表现[76.9％ (20/26)],且冠状动脉内血栓的比例[30.8％ (8/26)]高于单纯冠心病组[11.8％ (65/552),P＜0.05].结论 SLE初发冠心病患者传统危险因素较少,且以ACS为主要首发表现,冠状动脉造影提示冠状动脉内血栓的比例明显增加.为预防心血管事件,在治疗SLE的过程中应注意合理使用激素并设法减少因SLE导致的蛋白尿.
목적 총결계통성홍반랑창( SLE)환자초차발생관심병적림상특점.방법 선자1995년지2010년해방군총의원명학진단위SLE공3911례환자,기중경관상동맥조영증실위초발관심병적공26례,대조조선자2010년해방군총의원수치적경관상동맥조영증실적초발관심병환자병배제소유결체조직성질병공552례,대각조적전통관심병위험인소、제일차심혈관사건발작시적정황、혈생화지표、SLE적활동화치료정황이급관상동맥조영결과진행회고성분석,SLE조안시부이급성관상동맥종합정(ACS)위수발표현분위ACS아조(16례)화비ACS아조(10례),진일보진행조내비교.결과 여단순관심병조비교,SLE조초발관심병시년령교소[(50.4±15.2)세비(60.6±11.6)세,P＜0.01],전통위험인소교소[(1.11±1.18)개비(2.50±1.28)개]；이SLE합병조발관심병아조(20례)적전통위험인소경소,부위(0.75±1.02)개,기중13례(65.0％)이ACS위수발표현.SLE병발ACS아조적격소사용루계시간[24.00(3.75,57.00)개월비1.00(0.00,2.00)개월,P＜0.05]화24h뇨단백정량[(1.93±1.97)g비(0.76±0.75)g,P＜0.05]명현고우SLE비ACS아조.관상동맥조영결과현시SLE합병관심병조잉이동맥죽양경화협착위주요표현[76.9％ (20/26)],차관상동맥내혈전적비례[30.8％ (8/26)]고우단순관심병조[11.8％ (65/552),P＜0.05].결론 SLE초발관심병환자전통위험인소교소,차이ACS위주요수발표현,관상동맥조영제시관상동맥내혈전적비례명현증가.위예방심혈관사건,재치료SLE적과정중응주의합리사용격소병설법감소인SLE도치적단백뇨.
Objective To analyze the clinical characteristics of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).Methods Clinical data of 3911 SLE patients were retrospectively analyzed and CAD was diagnosed by coronary angiography in 26 (0.7％ ) SLE patients (10 stable angina pectoris,5 unstable angina pectoris,8 STEMI and 3 non-STEMI).The tradition risk factors,first onset of cardiac events,blood biochemistry index,treatment and activity of SLE,coronary angiographic features were compared with 552 CAD patients without SLE.Results Compared with CAD patients without SLE,CAD patients with SLE were younger [ (50.4 ± 15.2) years vs.(60.6 ± 11.6 ) years,P＜0.01 ],the mean number per patient of Framingham tradition risk factors was less ( 1.11 ± 1.18 vs.2.50 ± 1.28,P ＜0.05 ).CAD patients with SLE were prone to premature coronary artery disease [ 76.9％ (20/26) ],and ACS was the most common manifestation in SLE patients with premature coronary artery disease [ 65.0％ ( 13/20 ) ],the duration of steroid use was significantly longer [ 24.00 ( 3.75,57.00 )months vs.1.00 (0.00,2.00 ) months,P ＜ 0.05 ] and 24 hours total urine protein [ ( 1.93 ± 1.97 ) g vs.(0.76 ±0.75 )g,P ＜0.05] was significantly higher in the ACS patients with SLE than non-ACS patients with SLE.Coronary stenosis was evidenced in most of the SLE patients with CAD [ 76.9％ ( 20/26 ) ] and incidence of coronary thrombotic occlusion was significantly higher in SLE patients with CAD than CAD patients without SLE [ 30.8％ ( 8/26 ) vs.11.8％ ( 65/552 ),P ＜ 0.05 ].Conclusion The incidence of CAD in SLE patients is low and the major form of CAD in SLE patients is premature coronary artery disease and mostly induced by coronary thrombotic occlusion.