系统性红斑狼疮合并冠心病的临床特点及危险因素研究

目的 分析系统性红斑狼疮(SLE)并发冠状动脉性心脏病(冠心病)患者的临床特点,评价传统及非传统动脉粥样硬化危险因素对SLE患者发生冠心病的影响.方法 选取我院SLE并发冠心病的患者32例作为冠心病组,同时选取与其年龄和性别匹配的SLE但无冠心病症状或事件记录的患者64例作为对照组.对冠心病组的临床特点进行回顾性分析,并在传统危险因素、SLE情况等方面对2组进行单因素比较及多因素Logistic回归分析.结果 32例并发冠心病的患者中12例接受了冠状动脉造影或冠状动脉CT检查,11例为动脉粥样硬化病变,其中10例存在>75%的重度冠状动脉狭窄,多支病变多见.与无冠心病的对照组进行单因素比较,冠心病组患者具有更多的传统危险因素个数[(3.9±1.8)和(2.0±1.6)个,P<0.01],其中高血压、高脂血症、绝经及吸烟患者的数量明显多于对照组.SLE相关因素方面:冠心病组患者SLE病程更长[12.0(6.3~19.8)和2:0(0.8～9-0)年,P<0.01],糖皮质激素应用总量更多[28.8(0～49.8)和24.0(0~24.6)g,P<0.05];对照组患者补体C3水平更低[(750±364):和(598±267)mg/L,P<0.05]:SLE相关的脏器受累、其他免疫学指标、狼疮疾病活动性评分在2组间差异均无统计学意义.多因素分析显示,患者所具有的传统危险因素的数量及SLE病程是SLE患者并发冠心病的独立危险因素.结论 动脉粥样硬化是SLE患者出现冠状动脉病变的常见病理改变.传统危险因素在SLE患者动脉粥样硬化的发生中仍然发挥了重要作用,但SLE的病程也是导致动脉粥样硬化发生的独立危险因素.重视财传统危险因素的控制对防治动脉粥样硬化的发生具有重要的临床意义,随着SLE病程的延长,更应该加强对于动脉粥样硬化的监测与防治.

Abstract：

Objective To assess the clinical features and risk factors of coronary heart disease(CHD)in patients with systemic lupus erythematosus (SLE).Methods The clinical data of 32 lupus patients with CHD and 64 age and sex-matched lupus patients without CHD from a total of 1792 in-patients with lupus from January 1994 to December 2008 were collected and retrospectively analyzed.The traditional risk factors of atherosclemsis as well as their association with the characteristics of lupus were evaluated and compared between the two group of patients.Results The average age of CHD group was(51±12)years with an average disease duration of((8±6) years、.The most common coronary events were acute myocardial infaretio(53%)and non-stable,angina[34%).Among the 12 patients who accepted coronary angiography or computed tomography scan of coronary artery,11 patients had significant atheroselerosis lesions and 1 had thrombosis in coronary arteries.Their atheroselerosis lesions were severe,which manifested as diffuse stenosis and severe calcification.Compared to the control group,the CHD group patients had more traditional risk factors[(3.9±1.8)vs(2.0±1.6),P<0.01 j as well as higher prevalence of hypertension,hyperlipidemia,postmenopausal and smoking(P<0.05).Meanwhile,the CHD group patients had longer SLE duration[12.0(6.3~19.8)vs 2.0[O.8～9.0)years,P<0.01)J,higher C3 level[(750±364)vs(598±267)mg/L,P<0.05]and higher totalprednisone dose[28.8(0~49.8)vs 24.0(0~24.6)g,P<0.05]compared to patients without CHD.No significant differences were found in auto-antibodies,SLE disease activity,organ damage,average Drednisone dose and cyclophosI,hamide usage between the two groups of patients.Multi-variate analysls showed more traditional risk factors(OR:1.62)and longer SLE duration(OR=1.09)Were independent predictors of CHD.Condusion Atherosclerosis is a common pathological change of coronary in lupus patients with CHD.Traditional risk flactors of atherosclerosis and lupus duration are identified to be the independent risk factors of CHD in SLE patients.Early interventions for traditional risk factors and appropriate control of lupus arerecommended.

The analysis of clinical features and risk factors for coronary heart disease in systemic lupus erythematosus

Objective To assess the clinical features and risk factors of coronary heart disease(CHD)in patients with systemic lupus erythematosus (SLE).Methods The clinical data of 32 lupus patients with CHD and 64 age and sex-matched lupus patients without CHD from a total of 1792 in-patients with lupus from January 1994 to December 2008 were collected and retrospectively analyzed.The traditional risk factors of atherosclemsis as well as their association with the characteristics of lupus were evaluated and compared between the two group of patients.Results The average age of CHD group was(51±12)years with an average disease duration of((8±6) years、.The most common coronary events were acute myocardial infaretio(53%)and non-stable,angina[34%).Among the 12 patients who accepted coronary angiography or computed tomography scan of coronary artery,11 patients had significant atheroselerosis lesions and 1 had thrombosis in coronary arteries.Their atheroselerosis lesions were severe,which manifested as diffuse stenosis and severe calcification.Compared to the control group,the CHD group patients had more traditional risk factors[(3.9±1.8)vs(2.0±1.6),P<0.01 j as well as higher prevalence of hypertension,hyperlipidemia,postmenopausal and smoking(P<0.05).Meanwhile,the CHD group patients had longer SLE duration[12.0(6.3~19.8)vs 2.0[O.8～9.0)years,P<0.01)J,higher C3 level[(750±364)vs(598±267)mg/L,P<0.05]and higher totalprednisone dose[28.8(0~49.8)vs 24.0(0~24.6)g,P<0.05]compared to patients without CHD.No significant differences were found in auto-antibodies,SLE disease activity,organ damage,average Drednisone dose and cyclophosI,hamide usage between the two groups of patients.Multi-variate analysls showed more traditional risk factors(OR:1.62)and longer SLE duration(OR=1.09)Were independent predictors of CHD.Condusion Atherosclerosis is a common pathological change of coronary in lupus patients with CHD.Traditional risk flactors of atherosclerosis and lupus duration are identified to be the independent risk factors of CHD in SLE patients.Early interventions for traditional risk factors and appropriate control of lupus arerecommended.