目的 探讨多发性大动脉炎(TA)合并心脏损害患者的临床特点及相关独立危险因素.方法 回顾性分析85例TA中55例合并心脏损伤患者的临床资料,包括患者临床症状、体格检查、实验室检查、影像学检查结果;根据超声心动图及冠状动脉CT血管成像结果评估患者心脏损害情况,并与同期未合并心脏损害的30例TA患者进行比较.结果 55例合并心脏损害的TA患者中女47例,男8例,确诊时间与同期未合并心脏损害的TA患者比较[36(9,168)个月比12(6,24)个月],差异有统计学意义(P＜0.05);临床症状不典型,与无心脏损害的TA患者比较易出现胸背痛及双上肢动脉压差＞10 mmHg(1 mmHg =0.133 kPa)症状[27.3％ (15/55)比6.7％ (2/30)、69.1％ (38/55)比46.7％ (14/30)](均P＜0.05);实验室检查发现红细胞沉降率升高35例(63.6％),C反应蛋白(CRP)升高32例(58.2％),与未存在心脏损害患者的红细胞沉降率升高[17例(56.7％)]及CRP升高[16例(53.3％)]比例比较差异均无统 计学意义(均P＞0.05);临床分型为Ⅰ型13例(23.6％)、Ⅱ型11例(20.0％)、Ⅲ型28例(50.9％)、Ⅰ+Ⅳ型1例、Ⅲ+Ⅳ型2例;高血压性心脏病30例(54.5％),其中有肾动脉狭窄或闭塞18例,起病平均年龄(28±14)岁,与无肾动脉受累患者[(44±14)岁]比较,差异有统计学意义(P＜0.05);心肌病变6例(10.9％),左心室射血分数(LVEF)平均值为(34±8)％,无心肌病变的TA患者LVEF平均值为(66±7)％,2组比较差异有统计学意义(P＜0.05),且TA合并心肌病变患者起病年龄[(15±13)岁]与无心肌病变TA患者[(25±11)岁]比较,差异有统计学意义(P＜0.05);心脏瓣膜病变36例(65.5％);冠状动脉病变9例(16.4％);肺动脉高压7例(12.7％),平均静息肺动脉收缩压(62±22) mmHg,均无明显右心衰竭表现.Logistic回归分析结果显示CRP升高是肺动脉高压(比值比=0.082,95％置信区间:0.007～ 0.965,P＜0.05)、二尖瓣关闭不全(比值比=0.192,95％置信区间:0.040 ～ 0.929,P＜0.05)和三尖瓣关闭不全(比值比=0.093,95％置信区间:0.011 ～ 0.761,P＜0.05)的独立危险因素.结论 TA出现心脏损害并不少见,临床医师应关注其临床特征,早诊断早治疗,有助于减少TA患者心脏损害的发生.%Objective To explore manifestations and risk factors of cardiac involvement in patients with Takayasu's arteritis (TA).Methods Data of 55 TA patients complicated with cardiac injury among 85 TA patients,including clinical manifestations and results of physical,laboratory,imaging examination,were retrospectively analyzed.The cardiac injury was assessed by echocardiography and coronary CT angiography CT.Relative clinical data of TA patients complicated with cardiac injury were compared withTA patients without cardiac injury.Results In the 55 patients,47 were female and 8 were male.The time of confirmed diagnosis in TA patients with cardiac injury was significantly later [36 (9,168)months vs 12 (6,24) months],compared with that in TA patients without cardiac injury;meanwhile chest pain and blood pressure difference ＞ 10 mmHg between right-to-left sides were more like to occur [27.3％ (15/55) vs 6.7％ (2/30),69.1％ (38/55) vs 46.7％ (14/30)] (P ＜ 0.05).The proportions of patients with increased erythrocyte sedimentation rate and C reactive protein were not statistically different between TA patients with or without cardiac injury [63.6％ (35/55) vs 56.7％ (17/30),58.2％ (32/55) vs 53.3％ (16/30)] (P ＞ 0.05).In TA patients with cardiac injury,there were 13 of type Ⅰ (23.6％),11 of type Ⅱ (20.0％),28 of type Ⅲ (50.9％),1 of type Ⅰ +Ⅳ (1.8％),2 of type Ⅲ+ Ⅳ (3.6％);30 patients (54.5％) had hypertensive heart disease,including 18 of renal arterial stenosis or occlusion the onset hypersension were of (28 ± 14) years,which was younger than those without renal arterial involvement [(44 ± 14) years] (P ＜ 0.05);6 patients (10.9％) had old of age cardiomyopathy,showing a lower left ventricular ejection fraction and a younger onset age compared with patients without acardiomyopathy [(34±8)％vs (66±7)％,(15±13) years vs (25±11) years] (P＜0.05);36 patients (65.5％) had valvular disease;9 patients (16.4％) had coronary artery disease;7 patients (12.7％) had pulmonary hypertension with rest pulmonary arterial systolic pressure of (62 ± 22) mmHg,but there was no manifestation of right heart failure.Multivariate analysis showed that higher CRP was an independent risk factor of pulmonary hypertension [odds ratio(OR) =0.082,95％ confidence interval (CI):0.007-0.965,P ＜ 0.05],mitral valve regurgitation (OR =0.192,95％ CI:0.040-0.929,P ＜ 0.05) and tricuspid regurgitation (OR =0.093,95％ CI:0.011-0.761,P ＜ 0.05).Conclusion Cardiac involvement is not rare in TA;special attention should be paid to the cardiac manifestation,and early diagnosis and treatment can reduce cardiac injury.
展开▼
