CAJ | 학술논문

目的探讨SLE超声心动图特点及SLE并发肺高压(SLE-PH)的危险因素.方法总结598例SLE患者的超声心动图表现,对107例疑诊SLE-PH[超声心动图估测肺动脉收缩压(PASP)≥40mmHg]和64例疑诊中重度PH(PASP≥50 mmHg)患者的临床特点进行回顾性分析.采用t检验、x2检验及Logistic回归模型进行统计学分析.结果 423例(70.7％)患者超声心动图异常,表现为心包积液272例(45.5％)、瓣膜关闭不全187例(31.3％)、疑诊PH 107例(17.9％)、左心室增大35例(5.9％)、左心室肥厚26例(4.3％)、右心室增大39例(6.5％)、左心室射血分数(LVEF)＜50％ 36例(6.0％)、右心室收缩功能减低13例(2.2％)等.Logistic回归分析显示雷诺现象(OR=3.205,95％CI:1.911～5.375,P=0.000)、血小板减低(OR=1.680,95％CI:1.049～2.689,P=0.031)、高尿酸血症(OR =3.643,95％CI:2.154～6.164,P=0.000)及抗U1-RNP抗体阳性(OR=1.777,95％CI:1.099～2.874,P=0.019)是疑诊SLE-PH的独立危险因素,发热(OR=0.576,P=0.029)、皮疹(OR=0.558,P=0.017)则是疑诊SLE-PH的独立保护因素;病程(OR=1.145,95％CI:1.016～1.290,P=0.026)和雷诺现象(OR=3.371,95％CI:1.126～10.086,P=0.030)是疑诊中重度PH的独立危险因素,肾病综合征(OR=0.042,P=0.009)则是疑诊中重度PH的独立保护因素.结论 SLE患者普遍存在心脏受累,并发PH者不少见.临床上伴有血小板减少、抗U1-RNP抗体阳性、高尿酸血症尤其是伴发雷诺现象的SLE患者应注意筛查PH,早期诊断,早期治疗.
목적 탐토SLE초성심동도특점급SLE병발폐고압(SLE-PH)적위험인소.방법 총결598례SLE환자적초성심동도표현,대107례의진SLE-PH[초성심동도고측폐동맥수축압(PASP)≥40mmHg]화64례의진중중도PH(PASP≥50 mmHg)환자적림상특점진행회고성분석.채용t검험、x2검험급Logistic회귀모형진행통계학분석.결과 423례(70.7％)환자초성심동도이상,표현위심포적액272례(45.5％)、판막관폐불전187례(31.3％)、의진PH 107례(17.9％)、좌심실증대35례(5.9％)、좌심실비후26례(4.3％)、우심실증대39례(6.5％)、좌심실사혈분수(LVEF)＜50％ 36례(6.0％)、우심실수축공능감저13례(2.2％)등.Logistic회귀분석현시뢰낙현상(OR=3.205,95％CI:1.911～5.375,P=0.000)、혈소판감저(OR=1.680,95％CI:1.049～2.689,P=0.031)、고뇨산혈증(OR =3.643,95％CI:2.154～6.164,P=0.000)급항U1-RNP항체양성(OR=1.777,95％CI:1.099～2.874,P=0.019)시의진SLE-PH적독립위험인소,발열(OR=0.576,P=0.029)、피진(OR=0.558,P=0.017)칙시의진SLE-PH적독립보호인소;병정(OR=1.145,95％CI:1.016～1.290,P=0.026)화뢰낙현상(OR=3.371,95％CI:1.126～10.086,P=0.030)시의진중중도PH적독립위험인소,신병종합정(OR=0.042,P=0.009)칙시의진중중도PH적독립보호인소.결론 SLE환자보편존재심장수루,병발PH자불소견.림상상반유혈소판감소、항U1-RNP항체양성、고뇨산혈증우기시반발뢰낙현상적SLE환자응주의사사PH,조기진단,조기치료.
Objective To analyze the risk factors of pulmonary hypertension in patients with systemic lupus erythematosus (SLE-PH).Methods Echo data of 598 SLE patients were collected,clinical characteristics of 107 suspected SLE-PH (PASP ≥40 mmHg,estimated by Echo) and 64 suspected moderate to severe PH (PASP ≥50 mmHg) were retrospectively analyzed.T-test,x2-test and Logisticregression were used for statistical analysis.Results Out of 598 patients 70.7％(423 patients) had abnormal Echo findings,and pericardial effusion in 45.5％(272 cases),valvular insufficiency in 31.3％(187 cases),suspected PH in 17.9％(107 cases),left ventricular enlargement in 5.9％(35 cases),left ventricular hypertrophy in 4.3％(26cases).In addition 1.7％ had mitral valve prolapse,1.5％ had mitral valve vegetation,and right ventricular enlargement in 6.5％(39 cases),LVEF＜50％ in 6.0％(36 cases),right ventricular systolic dysfunction in 2.2％(13 cases).Logistic regression analysis showed Raynaud's phenomenon (OR=3.205,95％CI:1.911-5.375,P=0.000),thrombocytopenia (OR=1.680,95％CI:1.049-2.689,P=0.031),hyperuricemia (OR=3.643,95％CI:2.154-6.164,P=0.000),and anti-U1RNP antibody positivity (OR=1.777,95％CI:1.099-2.874,P=0.019)were independent risk factors for suspected SLE-PH,fever (OR=0.576,P=0.029)and rash (OR=0.558,P=0.017) were independent protective factors for suspected SLE-PH.SLE duration (OR=1.145,95％CI:1.016-1.290,P=0.026) and Raynaud's phenomenon (OR=3.371,95％CI:1.126-10.086,P=0.030)were independent risk factors for suspected moderate to severe PH,nephritic syndrome (OR=0.042,P=0.009) was the in dependent protective factor for suspected moderate to severe PH.Conclusion Cardiac involvement is common in SLE patients.Screening for PH should be considered in SLE patients with thrombocytopenia,hyperuricemia,anti-U1RNP antibody positivity,particularly with Raynaud's phenomenon.