嗜酸性肉芽肿性多血管炎心脏受累的临床特征分析
Clinical analysis of cardiac involvement in eosinophilic granulomatosis with polyangiitis
李杰 1张隽 1王晶 1华琳 2张黎明1
作者信息
- 1. 100043 北京,首都医科大学附属北京朝阳医院-北京市呼吸病研究所 呼吸与危重症医学科
- 2. 100069 北京,首都医科大学生物医学工程学院智能医学工程学学系
- 折叠
摘要
目的 分析嗜酸性肉芽肿性血管炎(EGPA)患者心脏受累的临床特点.方法 回顾性分析2005年5月至2021年12月于首都医科大学附属北京朝阳医院收治的确诊EGPA患者的临床资料,比较心脏受累组和非心脏受累组患者的差异,并随访两组的预后.结果 104例EGPA患者中,男性55例,女性49例,确诊时中位年龄56(46,65)岁,其中20例(19.2%)患者ANCA阳性.心脏受累组50例(48.1%),非心脏受累组54例(51.9%).心脏受累组中16例(32.0%)患者有心脏受累相关症状,25例(50%)心电图异常,34例(68%)心脏超声检查异常.6例行心脏增强核磁检查,5例发现心脏受累,其中2例为隐匿性心脏受累.心脏受累组中老年患者、基础疾病合并高血压病患者明显高于非心脏受累组(P＜0.05).两组之间嗜酸粒细胞计数及ANCA阳性率无明显差异(P＞0.05).平均随访中位时间41(19,59)月,6例患者死亡,均有心脏受累患者,其中3例死于心功能衰竭,另外3例分别死于脑梗死合并肺部感染、侵袭性肺曲霉菌病及肺恶性肿瘤.结论 EGPA患者中心脏受累比例高,临床表现缺乏特异性.心脏MRI有利于发现隐性的心脏受累.心脏受累与嗜酸性粒细胞计数及ANCA无明显相关性.心脏受累是疾病死亡的危险因素.
Abstract
Objective To describe the clinical features of cardiac involvement in patients with eosinophilic granulomatosis with polyangiitis(EGPA).Methods Patients who fulfilled the criteria of EGPA managed at the Affiliated Beijing Chaoyang Hospital of Capital Medical University from May 2005 to December 2021 were retrospectively analyzed.The clinical data of patients with cardiac involvement were analyzed,and the differences between patients with cardiac involvement and patients without cardiac involvement were compared.Results There were 104 patients included,55 males and 49 females,mean age at onset was 56(46,65)years old.ANCA positive was found in 20 patients(19.2%).Fifty patients(48.1%)had cardiac involvement,of which 16 patients(32%)had symptoms related to cardiac involvement,25 patients(50%)had an abnormal electrocardiogram,and 34 patients(68%)had the abnormal cardiac ultrasound.6 patients underwent cardiac magnetic resonance imaging(MRI),and cardiac involvement was found in 5 patients,including two patients with occult cardiac involvement.The proportion of elderly-aged patients with hypertension was significantly higher in the cardiac involvement group than those without cardiac involvement.The two groups had no significant difference in eosinophil count and ANCA positive rate.The median follow-up time was 41(19,59)months.Six patients died,all with cardiac involvement.Three patients died of heart failure,and the other three patients died of cerebral infarction complicated with pulmonary infection,pulmonary aspergillus infection,and pulmonary malignancy.Conclusion Cardiac involvement is common in patients with EGPA,and the clinical manifestations are lack of specificity.Cardiac MRI is beneficial in detecting occult cardiac involvement.There was no significant correlation between cardiac involvement with eosinophil count and ANCA.Cardiac involvement is a risk factor for mortality.
关键词
心脏MRI/嗜酸性肉芽肿性多血管炎/心脏受累/预后Key words
Cardiac MRI/Eosinophilic granulomatosis with polyangiitis/Cardiac involvement/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据