【摘要】 目的探讨累及心脏损害的系统性红斑狼疮(SLE)患者的临床病理特征及预后,为提高SLE的诊治水平提供依据。方法选取2008年1月至2012年12月我院收治的128例SLE患者作为研究对象,回顾性分析所有患者的临床及随访资料,根据其资料结果记录所有患者性别、年龄及SLE病程等一般临床资料、相关临床指标水平以及累及心脏等其他系统损害情况,以及预后生存状况,并比较是否累及心脏损害的SLE患者间上述资料差异性。结果 (1)本研究128例SLE患者中累及心脏损害74例,累及损害率为57.81%;(2)累及心脏损害的SLE患者其吸烟,累及血液、神经和肾脏系统损害比例显著较高,且TG、TC、ALT、AST、CRP和TNF-α水平均显著高于未累及心脏损害的SLE患者(P<0.05);(3)累及心脏损害和未累及心脏损害的SLE患者5年总生存率比较具有统计学意义(χ2=15.441,P<0.001);(4)经Log-rank检验单因素分析显示:不同年龄、病程以及是否累及心脏、神经及肾脏系统损害的SLE患者预后生存时间比较均存在差异(P<0.05);(5)经多元Cox逐步回归分析结果可得年龄过大、病程较长以及累及心脏、肾脏和神经系统损害均为影响SLE患者预后生存的独立危险因素(P<0.05)。结论随着病情进展,大部分患者可累及心脏损害,且该类SLE患者吸烟、累及血液、神经和肾脏系统损害比例显著较高,免疫力低下且存在一定的炎性反应,且当累及心脏损害时可为影响SLE患者预后的独立危险因素。更多还原

【Abstract】 Objective To investigate the clinical pathological features and prognosis of patients with systemic lupus erythematosus( SLE) involving heart damage,and to provide data for improving the diagnosis and treatment of SLE. Methods A total of 128 patients with SLE admitted to our hospital between January 2008 and December 2012 were selected as the subjects of this study. The clinical and follow-up data of all the patients was analyzed retrospectively. According to the results of the data,the patients’ general clinical data,including gender,age,the course of SLE,relevant clinical indicators,and other systemic impairment involving the heart and prognosis,were recorded,and the difference in the above data between SLE patients with cardiac impairment and those without was compared. Results( 1) In this study,there were 74 cases of cardiac injury among the 128 patients with SLE,and the injury rate was 57. 81%.( 2) The proportion of smokers and damage involving blood,nervous and renal systems was significantly higher in patients with SLE who suffered from cardiac damage,and the levels of TG,TC,ALT,AST,CRP and TNF-α were significantly higher than those of SLE without cardiac damage( P<0. 05).( 3) The difference in the5-year overall survival rate between SLE patients with cardiac damage and those without non-cardiac involvement was statistically significant( χ~2= 15. 441,P<0. 001).( 4) Univariate analysis by Log-rank test showed that the survival time of SLE patients varied with age,disease duration,and the occurrence of cardiac,neurological,and renal system damage( P<0. 05).( 5) The multivariate Cox stepwise regression analysis results showed that old age,longer duration,and involvement of the heart,kidney,and nervous systems were all independent risk factors that affected the prognosis of SLE patients( P < 0. 05). Conclusion With the progression of the disease,most patients suffer from cardiac damage,and the proportion of smokers and damage involving the blood,nervous and renal systems is significantly higher among this type of SLE patients who are afflicted with low immunity and inflammatory reactions. The involvement of cardiac damage is an independent risk factor for the prognosis of SLE patients.更多还原