CAJ | 학술논문

目的应用美国超声心动图学会(ASE)指南推荐的右心功能指标评价系统性红斑狼疮(SLE)存在和不存在肺动脉高压时的表现,探讨反映患者右心功能减退最敏感的指标,并分析其与肺动脉压和肺血管阻力的关系.方法研究对象为SLE患者43例,按照肺动脉收缩压的高低分为二组:SLE无肺动脉高压组24例(肺动脉收缩压≤35 mm Hg)；SLE合并肺动脉高压组19例(肺动脉收缩压＞35mm Hg).正常对照组22例.三组患者间年龄及性别构成均无显著性差异.对所有患者测定26项右心功能超声指标,比较各组间指标的差别,分析肺动脉压和肺血管阻力对右心功能的影响.结果单因素方差分析显示,三组间比较有17项指标差异有统计学意义(P＜0.05).其中三尖瓣收缩期位移和三尖瓣血流E/A比值在SLE无肺动脉高压组已经较正常组降低(P=0.04和0.03).有11项指标能反映SLE合并或不合并肺动脉高压的差别(P＜0.05).多元Logistic回归分析示肺血管阻力升高者右心功能减退的可能性较肺血管阻力正常者高出6倍以上(odds ratio=6.18,P=0.02).结论 SLE患者右室功能受损的程度同肺血管阻力及肺动脉收缩压升高的程度相关.肺血管阻力升高是右心功能受损的重要预测因子.
목적 응용미국초성심동도학회(ASE)지남추천적우심공능지표평개계통성홍반랑창(SLE)존재화불존재폐동맥고압시적표현,탐토반영환자우심공능감퇴최민감적지표,병분석기여폐동맥압화폐혈관조력적관계.방법 연구대상위SLE환자43례,안조폐동맥수축압적고저분위이조:SLE무폐동맥고압조24례(폐동맥수축압≤35 mm Hg)；SLE합병폐동맥고압조19례(폐동맥수축압＞35mm Hg).정상대조조22례.삼조환자간년령급성별구성균무현저성차이.대소유환자측정26항우심공능초성지표,비교각조간지표적차별,분석폐동맥압화폐혈관조력대우심공능적영향.결과 단인소방차분석현시,삼조간비교유17항지표차이유통계학의의(P＜0.05).기중삼첨판수축기위이화삼첨판혈류E/A비치재SLE무폐동맥고압조이경교정상조강저(P=0.04화0.03).유11항지표능반영SLE합병혹불합병폐동맥고압적차별(P＜0.05).다원Logistic회귀분석시폐혈관조력승고자우심공능감퇴적가능성교폐혈관조력정상자고출6배이상(odds ratio=6.18,P=0.02).결론 SLE환자우실공능수손적정도동폐혈관조력급폐동맥수축압승고적정도상관.폐혈관조력승고시우심공능수손적중요예측인자.
Objective To evaluate the right heart dysfunction in SLE patients with/ without pulmonary arterial hypertension (PAH) using the parameters recommended by the American Society of Echocardiography (ASE),and to examine whether the right heart dysfunction is directly related to elevated pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR).Methods Study population composited of 43 patients with SLE.The patients were divided into two groups according to the PASP measured by echocardiography:Group A was 24 patients with PASP ≤35 mm Hg,Group B was 19patients with PASP＞35 mm Hg.Twenty-two healthy subjects with age and gender matched were set as control group.Routine transthoracic echocardiography study was performed on all patients and 26 parameters were measured in order to compare the differences of the parameters among the three groups.Results There were significant differences in 17 parameters among the three groups (P ＜0.05).Tricuspid annular plane systolic excurtion(TAPSE) and E/A ratio of tricuspid flow velocities in SLE patients without PAH significantly decreased compared to control group (P =0.04 and 0.03).There were significant differences in 11 parameters between SLE with and without PAH group (P ＜0.05).Multivariate logistic regression analysis indicated that after adjustment for age and gender,the patients with elevated PVR associated with a 6.18-fold increase in right ventricular dysfunction compared to the patients with normal PVR (P =0.02).Conclusions The impairment of right ventricular function in SLE patients was directly related to PVR and PASP.Elevation of PVR was an important predictor for right heart dysfunction.