Ramonda R, Doria A, Villanova C, Vaccaro E, Punzi L, Fasoli G, Gambari P F
Service de Rhumatologie, Université de Padoue, Italie.
Rev Rhum Mal Osteoartic. 1992 Dec;59(12):790-6.
Thirty-five consecutive patients with systemic lupus erythematosus were enrolled in a prospective study. Investigations included a physical evaluation, tests for antinuclear antibodies and antiphospholipid antibodies, an electrocardiogram, a plain chest film, a 2D echocardiogram and a Doppler study. Clinical cardiac manifestations and alterations of the electrocardiogram were infrequent (17% and 11% of patients, respectively) and no patients had abnormal chest film findings. In contrast, echocardiographic abnormalities were common (82% of patients), although moderate in most instances. Pericardial involvement was found in 15 patients (42.8%); a pericardial effusion was seen in 9 of the 14 patients with inactive disease (p < 0.003), whereas thickening of the pericardium was visible in 4 patients with active disease and 2 of the 21 patients with inactive disease. Valve abnormalities were found in 17 patients (48.5%), but were not related to the presence of antiphospholipid antibodies; valve alterations included verrucous endocarditis in one case, valve thickening in one case, mitral prolapse in five cases, and mild or moderate regurgitation in 15 cases (aortic in 2 cases, mitral in 7 cases, pulmonary in 3 cases and tricuspid in 7 cases). Alterations in ventricular chamber size and kinetics were also fairly common, albeit of uncertain pathogenetic significance. These data confirm the value of 2D echocardiography for identifying and monitoring cardiac involvement in systemic lupus erythematosus, even in patients with no overt clinical manifestations.
35例连续性系统性红斑狼疮患者纳入一项前瞻性研究。检查包括体格评估、抗核抗体和抗磷脂抗体检测、心电图、胸部平片、二维超声心动图及多普勒检查。临床心脏表现及心电图改变不常见（分别占患者的17%和11%），且无患者胸部平片检查结果异常。相比之下，超声心动图异常常见（占患者的82%），不过多数情况为中度异常。15例患者（42.8%）发现心包受累；14例非活动性疾病患者中有9例出现心包积液（p<0.003），而4例活动性疾病患者及21例非活动性疾病患者中的2例可见心包增厚。17例患者（48.5%）发现瓣膜异常，但与抗磷脂抗体的存在无关；瓣膜改变包括1例疣状心内膜炎、1例瓣膜增厚、5例二尖瓣脱垂以及15例轻至中度反流（2例主动脉瓣、7例二尖瓣、3例肺动脉瓣、7例三尖瓣）。心室腔大小及动力学改变也相当常见，尽管其致病意义尚不确定。这些数据证实了二维超声心动图在识别和监测系统性红斑狼疮心脏受累方面的价值，即使在无明显临床表现的患者中亦是如此。
