Apte M, McGwin G, Vilá L M, Kaslow R A, Alarcón G S, Reveille J D
Department of Epidemiology, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA.
Rheumatology (Oxford). 2008 Mar;47(3):362-7. doi: 10.1093/rheumatology/kem371. Epub 2008 Feb 4.
To examine the factors associated with myocarditis and its impact on disease outcomes in SLE patients.
SLE patients aged > or = 16 yrs, disease duration < or = 5 yrs from LUMINA (LUpus in Minorities: NAture vs nurture), a multiethnic US cohort, were studied. Myocarditis was defined as per the category 3 of the pericarditis/myocarditis item of the SLAM-Revised (SLAM-R). Patients with concurrent pericardial involvement were excluded. Patients with myocarditis were compared with those without myocarditis or its sequelae in the preceding year. The association between myocarditis and baseline variables (T(0)) was first examined. The impact of myocarditis on disease activity over time (SLAM-R), damage accrual [SLICC Damage Index (SDI)] at last visit (T(L)) and mortality was evaluated.
Fifty-three of the 496 patients studied had myocarditis. African American ethnicity [Odds ratio (OR) = 12.6; 95% CI 1.6, 97.8] and SLAM-R at diagnosis (OR = 1.1, 95% CI 1.0, 1.1) were significantly and independently associated with myocarditis. Myocarditis did not predict disease activity over time, but approached significance as a predictor of SDI at T(L) in multivariable analyses P = 0.051. Kaplan-Meier curves indicated that myocarditis was associated with shorter survival (log-rank = 4.87, P = 0.02), particularly in patients with > or = 5 yrs disease; however, myocarditis was not retained in the Cox proportional hazards regression model.
Ethnicity and disease activity at diagnosis were associated with the occurrence of myocarditis in SLE. Myocarditis did not significantly impact on disease activity over time, but impacts some on damage accrual and survival, reflecting overall the more severe disease those patients experience.
探讨与系统性红斑狼疮（SLE）患者心肌炎相关的因素及其对疾病预后的影响。
对来自美国多民族队列LUMINA（少数民族狼疮：先天与后天）研究中年龄≥16岁、病程≤5年的SLE患者进行研究。心肌炎的定义依据修订版系统性红斑狼疮疾病活动度测量（SLAM-R）中的心包炎/心肌炎项目类别3。排除合并心包受累的患者。将心肌炎患者与前一年无心肌炎或其后遗症的患者进行比较。首先研究心肌炎与基线变量（T(0)）之间的关联。评估心肌炎对随时间变化的疾病活动度（SLAM-R）、末次随访（T(L)）时的损伤累积[系统性红斑狼疮国际协作临床（SLICC）损伤指数（SDI）]及死亡率的影响。
496例研究患者中有53例发生心肌炎。非裔美国人种族[比值比（OR）=12.6；95%置信区间（CI）1.6，97.8]及诊断时的SLAM-R（OR = 1.1，95% CI 1.0，1.1）与心肌炎显著且独立相关。心肌炎并不能预测随时间变化的疾病活动度，但在多变量分析中作为T(L)时SDI的预测因素接近显著水平（P = 0.051）。Kaplan-Meier曲线表明心肌炎与较短生存期相关（对数秩检验=4.87，P = 0.02），尤其是病程≥5年的患者；然而，心肌炎未保留在Cox比例风险回归模型中。
种族及诊断时的疾病活动度与SLE患者心肌炎的发生相关。心肌炎对随时间变化的疾病活动度无显著影响，但对损伤累积及生存期有一定影响，总体反映出这些患者经历的疾病更为严重。
