Ansari A, Larson P H, Bates H D
Prog Cardiovasc Dis. 1985 May-Jun;27(6):421-34. doi: 10.1016/0033-0620(85)90003-9.
Cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute fibrinous pericarditis and pericardial effusion. Echocardiography has demonstrated an increased incidence of pericardial effusion, even in those who have minimal symptoms. Chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely. While myocarditis is commonly noted at autopsy, it is often silent clinically. Diagnosis during life can be confirmed only by endomyocardial biopsy. Electrocardiographic changes are often nonspecific. Endocarditis with superimposed nonbacterial verrucous vegetations (Libman-Sacks) is noted in more than 40% of hearts at autopsy, but is rarely diagnosed during life. Valve dysfunctions, such as aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency, occasionally manifest during life and rarely may necessitate surgery. Atrial and ventricular arrhythmias, first degree AV block, and acquired CHB occur in association with pericarditis, myocarditis, vasculitis, and myocardial fibrosis, respectively. CCHB developing in newborns of mothers with SLE, particularly those who have an antibody to soluble tissue ribonuclear protein RO(SS-A), is increasingly being appreciated by both pediatric cardiologists and rheumatologists. Recently, severe coronary atherosclerosis resulting in angina pectoris and/or myocardial infarction in young adults has been noted, particularly in those who had developed risk factors such as hypertension and hyperlipidemia while receiving prolonged corticosteroid therapy. Rarely, coronary arteritis may produce similar symptoms. Congestive heart failure of either single or multiple etiologies carries an ominous prognosis. It remains a cause of high morbidity and mortality unless recognized early and treated properly. Extracardiac vascular manifestations of SLE include telangiectasia, vasculitis, livedo reticularis, Raynaud's phenomena, and thrombophlebitis, all of which may occur either alone or in different combinations. Evidence is now slowly accumulating that substantiates that immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for the majority of the cardiovascular manifestations of SLE, for example, pericarditis, myocarditis, endocarditis, coronary arteritis, coronary atherosclerosis, and systemic and pulmonary vasculitis.(ABSTRACT TRUNCATED AT 400 WORDS)
大多数系统性红斑狼疮（SLE）患者在病程中的某个阶段会出现心血管表现，最常见的是急性纤维素性心包炎和心包积液。超声心动图显示心包积液的发生率增加，即使在症状轻微的患者中也是如此。慢性粘连性心包炎、心包填塞和缩窄性心包炎很少见。虽然心肌炎在尸检时很常见，但临床上往往没有症状。生前诊断只能通过心内膜心肌活检来证实。心电图改变通常是非特异性的。尸检发现超过40%的心脏存在伴有非细菌性疣状赘生物（Libman-Sacks心内膜炎）的内膜炎，但生前很少诊断出来。瓣膜功能障碍，如主动脉瓣狭窄、主动脉瓣关闭不全、二尖瓣狭窄和二尖瓣关闭不全，偶尔在生前出现，很少需要手术治疗。房性和室性心律失常、一度房室传导阻滞和获得性完全性心脏传导阻滞（CHB）分别与心包炎、心肌炎、血管炎和心肌纤维化有关。患有SLE的母亲所生新生儿中发生的完全性心脏传导阻滞，尤其是那些具有抗可溶性组织核糖核蛋白RO（SS-A）抗体的新生儿，越来越受到儿科心脏病学家和风湿病学家的重视。最近，已经注意到严重冠状动脉粥样硬化在年轻人中导致心绞痛和/或心肌梗死，特别是那些在接受长期皮质类固醇治疗时出现高血压和高脂血症等危险因素的人。很少见的是，冠状动脉炎可能产生类似症状。单病因或多病因的充血性心力衰竭预后不佳。除非早期识别并正确治疗，否则它仍然是高发病率和死亡率的一个原因。SLE的心外血管表现包括毛细血管扩张、血管炎、网状青斑、雷诺现象和血栓性静脉炎，所有这些表现都可能单独出现或不同组合出现。现在有越来越多的证据证实免疫复合物沉积、补体激活以及随后的炎症反应是SLE大多数心血管表现的原因，例如心包炎、心肌炎、心内膜炎、冠状动脉炎、冠状动脉粥样硬化以及系统性和肺血管炎。（摘要截断于400字）
