摘要
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，对照组选白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。
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.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第5期378-381,共4页
Chinese Journal of Cardiology
