肺血管阻力对系统性红斑狼疮患者右心功能减退的预测效果

摘要

目的:探究超声心动图肺血管阻力(pulmonary vascular resistance,PVR)在预测系统性红斑狼疮(systemic lupus erythematosus,SLE)患者右心功能障碍中的价值.方法:将43例SLE患者根据超声心动图肺动脉收缩压(PASP)检测结果分为两组:A组(无肺动脉高压组,PASP≤30 mmHg,n=23)；B组(肺动脉高压组,PASP＞30 mmHg,n=20).所有患者均接受相应实验室检查,采用超声心动图检测患者PVR及右室面积变化分数(fractional area change,FAC),并分析临床、实验室及心脏超声各项指标与右心功能减退的关系.结果:两组SLE患者中,12项超声指标差异具有统计学意义(P＜0.01).将FAC＜35％作为应变量,经年龄和性别调整后行多元Logistic回归分析发现,FAC的降低仅与PVR相关[风险指数(odds ratio)=9.85,P=0.04].受试者工作特征曲线(receiver operator characteristic curve,ROC)分析显示,PVR＞ 1.45 wood单位预测FAC＜35％的曲线下面积(area under the curve,AUC)为0.91 (P＜0.001),敏感性为92％,特异性为68％.结论:PVR预测右心功能障碍的准确性及敏感性优于PASP,是评估SLE患者疗效和预后的新的预测因子.%Objective:To evaluate the value of ultrasonic cardiogram pulmonary vascular resistance (PVR) in the prediction of right ventricular dysfunction in patients with systemic lupus erythematosus (SLE).Methods:Forty-three SLE patients were divided into two groups according to the pulmonary artery systolic pressure (PASP) measured by echocardiography:group A (23patients with PASP ≤ 30 mmHg) and group B (20 patients with PASP＞ 30 mmHg).All patients underwent corresponding laboratory tests.PVR and fractional area change (FAC) were detected by ultrasonic cardiogram.Results:There were significant differences in 12 indexes between the two groups (P＜0.01).Taking FAC＜35％ as a dependent variable,after adjustment for age and gender,PVR was still related to right ventricular dysfunction(odds ratio =9.85,P =0.04)by multivariate logistic regression analysis.Receiver operator characteristic curve (ROC) analysis showed that the sensitivity and specificity for PVR＞1.45 wood in predicting FAC＜ 35％ were 92％ and 68％ (AUC:0.91,P＜0.001),respectively.Conclusions:PVR is a more accurate and sensitive predictor for right ventricular dysfunction compared with PASP.