Analysis of clinical features and related factors of systemic lupus erythematosus complicated with cardiovascular disease
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摘要:
目的 探讨系统性红斑狼疮(SLE)患者合并心血管疾病的临床特点以及潜在危险因素，以期为临床诊治工作提供一定的帮助。 方法 收集2021年12月—2022年12月在蚌埠医科大学第一附属医院风湿科诊治的202例SLE患者的临床资料，其中男性22例，女性180例。根据是否合并心血管疾病将患者分为合并心血管疾病的病例组(58例)和不合并心血管疾病的对照组(144例)，分析比较2组患者的临床资料。 结果 SLE合并心血管疾病患者共58例，患病率为28.7%。2组年龄、左颈总动脉阻力指数、左颈总动脉最大血流速度、血糖、血小板计数、IgG水平、C3、总胆固醇、D二聚体、抗磷脂抗体阳性率及病程差异均有统计学意义(P＜0.05)。Logistic回归分析显示，年龄增加、左颈总动脉阻力指数升高、高血糖、血小板以及IgG水平异常均为SLE患者并发心血管疾病的独立危险因素(P＜0.05)。 结论 SLE患者合并心血管疾病的发病率受多种因素共同影响，其中年龄的增大、抗磷脂抗体阳性状态、左颈总动脉阻力指数升高、血糖异常、血小板计数及IgG水平的异常是其潜在危险因素。因此，在临床实践中，应综合考虑这些因素，制定全面的风险评估和管理策略，以有效降低SLE患者的心血管疾病患病风险。 Abstract:Objective To examine the clinical characteristics and potential risk factors associated with systemic lupus erythematosus (SLE) patients with cardiovascular diseases. The findings of this study will contribute to the development of more accurate clinical diagnosis and treatment strategies for SLE patients with cardiovascular diseases. Methods The clinical data of 202 patients with SLE, comprising 22 males and 180 females, were collected from the Rheumatology Department of the First Affiliated Hospital of Bengbu Medical University between December 2021 and December 2022. The patients were divided into two groups: a case group comprising 58 patients with cardiovascular diseases and a control group comprising 144 patients without cardiovascular diseases. The clinical data of the two groups were subjected to analysis and comparison. Results There were a total of 58 SLE patients with cardiovascular diseases, with an incidence rate of 28.7%. There were statistically significant differences in age, left common carotid artery resistance index, left common carotid artery maximum blood flow velocity, blood glucose, platelet count, IgG level, C3, total cholesterol, D-dimer, antiphospholipid antibody positive rate, and disease duration between the two groups (P < 0.05). Logistic regression analysis showed that increased age, elevated left common carotid artery resistance index, hyperglycemia, platelet count, and abnormal IgG level were independent risk factors for SLE patients with cardiovascular diseases (P < 0.05). Conclusion The incidence rate of SLE patients with cardiovascular diseases is influenced by multiple factors, among which age increase, positive antiphospholipid antibody status, elevated left common carotid artery resistance index, abnormal blood glucose, platelet count, and abnormal IgG level are potential risk factors. It is therefore recommended that these factors should be taken into account in clinical practice in order to develop comprehensive risk assessment and management strategies which will effectively reduce the risk of cardiovascular disease in patients with SLE. -
表 1 2组SLE患者SLE相关抗体阳性率比较(%)
Table 1. Comparison of SLE-related antibody positive rates between the two groups of SLE patients (%)
组别 例数 抗Sm抗体 抗dsDNA抗体 抗心磷脂抗体 抗β2糖蛋白抗体 病例组 58 53.4(31/58) 65.5(38/58) 31.0(18/58) 22.4(13/58) 对照组 144 45.1(65/144) 63.2(91/144) 14.5(21/144) 7.5(11/144) χ2值 1.145 0.097 7.183 8.621 P值 0.285 0.756 0.007 0.003 
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表 2 2组SLE患者临床资料比较[M(P25, P75)]
Table 2. Comparison of clinical data between the two groups of SLE patients [M(P25, P75)]
项目 对照组 病例组 Z值 P值 年龄(岁) 41(31, 48) 49(39, 57) -4.404 ＜0.001 右颈总动脉内径(mm) 6.2(5.9, 6.7) 6.65(5.8, 7.1) -0.724 0.469 右颈总动脉最大血流速度(cm/s) 72.8(57.3, 84.68) 68.8(55.7, 77.3) -1.648 0.099 右颈总动脉阻力指数 0.68(0.65, 0.72) 0.67(0.63, 0.71) -1.201 0.230 左颈总动脉内径(mm) 6.2(5.9, 6.5) 6.1(5.8, 6.5) -0.612 0.541 左颈总动脉最大血流速度(cm/s) 78.0(63.7, 90.5) 65.3(56.1, 87.0) -2.051 0.040 左颈总动脉阻力指数 0.67(0.64, 0.71) 0.63(0.60, 0.69) -2.148 0.032 白细胞计数(×109/L) 5.37(3.86, 7.98) 4.90(3.16, 8.19) -0.703 0.482 血红蛋白(g/L) 116(102, 127) 114(94, 122) -1.142 0.253 血小板计数(×109/L) 189(122, 283) 158(129, 207) -2.937 0.003 血糖(mmol/L) 4.14(3.78, 4.57) 4.82(4.49, 5.52) -3.541 0.030 尿酸(μmol/L) 280(228, 360) 345(214, 395) -1.281 0.200 总胆固醇(mmol/L) 3.85(3.22, 4.77) 5.37(3.66, 6.82) -3.208 0.001 甘油三酯(mmol/L) 1.48(1.29, 2.01) 1.51(0.94, 2.65) -0.303 0.762 D-二聚体(mg/L) 0.33(0.23, 0.95) 0.93(0.63, 3.11) -4.533 ＜0.001 IgG(g/L) 13.00(9.89, 16.90) 11.20(7.37, 14.00) -4.419 ＜0.001 C3(g/L) 0.705(0.592, 0.787) 0.641(0.534, 0.795) -2.105 0.035 C4(g/L) 0.121(0.068, 0.169) 0.111(0.088, 0.192) -1.228 0.220 病程(年) 48(4, 120) 96(21, 120) -2.359 0.018
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表 3 SLE患者合并心血管疾病相关危险因素的logistic回归分析
Table 3. Logistic regression analysis on risk factors related to cardiovascular diseases in SLE patients
变量 B SE Waldχ2 P值 OR值 95% CI 左颈总动脉最大血流速度 -0.003 0.015 0.048 0.827 0.997 0.967~1.027 左颈总动脉阻力指数 0.113 0.057 3.934 0.047 1.120 1.001~1.252 C3 0.006 0.007 0.575 0.448 1.006 0.991~1.020 病程 -0.002 0.004 0.163 0.686 0.998 0.991~1.006 年龄 0.108 0.032 11.495 0.001 1.114 1.046~1.185 抗心磷脂抗体 -0.728 1.300 0.313 0.576 0.483 0.038~6.174 抗β2糖蛋白抗体 -2.524 1.502 2.823 0.093 0.080 0.004~1.522 D-二聚体 -0.132 0.076 3.031 0.082 0.876 0.755~1.017 IgG -0.256 0.100 6.596 0.010 0.774 0.637~0.941 血小板计数 -0.011 0.003 9.436 0.002 0.990 0.983~0.996 血糖 0.584 0.196 8.880 0.003 1.793 1.221~2.633 总胆固醇 0.168 0.203 0.684 0.408 1.183 0.794~1.763
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