系统性红斑狼疮并急性心血管事件63例分析:一项单中心回顾性研究

摘要

Objective To investigate incidence of cardiovascular events in patients with systemic lupus erythematosus (SLE), and to perform preliminary analysis for clinical characteristics and risk factors of acute heart failure (AHF) in order to provide research basis for prevention of SLE patients with acute cardiovascular events in emergency department.Methods Clinical data of SLE patients with acute cardiovascular events admitted during July 26th 2012 and July 22nd 2016 was analyzed by a single center retrospective study.Risk factors of SLE patients with acute cardiovascular events were analyzed by logistic regression analysis.Results Incidence rate of SLE patients with acute cardiovascular events was 17.17% (63/367) in the recent 4 years.The 63 patients visited doctors for dyspnea, chest pain and expiratory dyspnea, and duration of pathogenesy to visiting in emergency department was 4 (1, 12.5)d.There were 38 patients with AHF, 12 patients with peripheral angiopathy, 8 patients with acute coronary syndrome (ACS, included 4 patients with acute myocardial infarction), 3 patients with pericardial effusion and 1 patient with frequent ventricular premature beats and 1 patient with hypertrophic cardiomyopathy.Duration of this time pathogenesy to diagnosis of SLE was 4.25 (1, 8.25) years.In this study, 1 patient died (1.59%), and 62 patients had stable conditions after treatment, in which 21 patients (33.33%) were discharged, 11 patients (17.46%) were transferred to other hospitals, and less than 50% of all patients were transferred to other relevant departments for continued treatment.Logistic regression analysis showed that hypertension history was the risk factor of SLE patients combined with AHF (P=0.005, OR=10.536, 95% CI:2.023, 54.871);hyperlipidemia history(P=0.040, OR=0.111, 95% CI:0.014, 0.900), abnormal platelet counts (P=0.049, OR=0.990, 95% CI:0.981, 1.000) and valvular heart diseases (P=0.041, OR=0.151, 95% CI:0.025, 0.925) were the protective factors of SLE patients combined with AHF.Conclusion Clinical manifestations of SLE patients with cardiovascular events are especial, and therefore the therapy should be different from ordinary cardiovascular patients, and clinicians should improve understanding and research of cardiovascular events in SLE patients.%目的 调查系统性红斑狼疮(systemic lupus erythematosus, SLE)患者发生急性心血管事件的情况,初步分析SLE患者发生急性心力衰竭(acute heart failure, AHF)的临床特点及危险因素,为急诊科正确诊治SLE并急性心血管事件患者提供研究基础.方法 采用单中心回顾性研究,分析第四军医大学西京医院急诊科2012年7月26日-2016年7月22日收治的SLE并急性心血管事件患者临床资料,应用logistic回归分析SLE患者发生急性心血管事件的危险因素.结果 近4年我院急诊科SLE并急性心血管事件发生率为17.17%(63/367).63例患者以胸闷、胸痛及呼吸困难等主诉来院急诊,发病至急诊科就诊时长4(1,12.5)d,确诊SLE并AHF 38例、周围血管病12例、急性冠状动脉综合征8例(包括急性心肌梗死4例)、心包积液3例、频发室性早搏及肥厚性心肌病各1例,本次发病距诊断SLE时长4.25(1,8.25)年.本组死亡1例(1.59%),62例经治疗病情较稳定后,出院21例(33.33%),转院11例(17.46%),仅不足50%的患者转相关专科继续治疗.logistic回归分析显示,高血压病史是SLE合并AHF的危险因素(P=0.005, OR=10.536,95% CI:2.023,54.871);高脂血症病史(P=0.040,OR=0.111,95% CI:0.014,0.900)、血小板计数异常(P=0.049,OR=0.990,95% CI:0.981,1.000)、心脏瓣膜病(P=0.041,OR=0.151,95% CI:0.025,0.925)是其保护因素.结论 SLE相关心血管事件临床表现有一定特点,治疗不同于一般急性心血管事件患者,临床医师亟待加强对SLE并急性心血管事件的认知和研究.