中国 Takayasu 动脉炎患者心脏受累的临床特征。
Clinical Characteristics of Heart Involvement in Chinese Patients with Takayasu Arteritis.
机构信息
From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; Department of Rheumatology, Ji-shui-tan Hospital, Beijing, China.
J. Li, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; H. Li, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, and Department of Rheumatology, Ji-shui-tan Hospital; F. Sun, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; Z. Chen, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; Y. Yang, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; J. Zhao, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; M. Li, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; X. Tian, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; X. Zeng, MD, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education.
出版信息
J Rheumatol. 2017 Dec;44(12):1867-1874. doi: 10.3899/jrheum.161514. Epub 2017 Aug 15.
OBJECTIVE
To understand the characteristics of heart involvement in Chinese patients with Takayasu arteritis (TA).
METHODS
The medical charts of 411 patients with TA (325 women, 86 men) were retrospectively reviewed. The comparison of clinical manifestations was carried out between the patients with TA with (n = 164) and without (n = 247) heart involvement.
RESULTS
The median age at disease onset was 23.0 years (18.0-30.0) in 411 patients with TA, and 23.0 years (17.3-30.0) in 164 patients with heart involvement. The disease duration of the heart involvement group (median: 24.0 mos) was significantly longer than those patients without heart involvement (the control group, median: 16.0 mos). Hypertension (57.3% vs 46.6%; p = 0.033), renal dysfunction (17.1% vs 7.7%; p = 0.003), and bruit in the subclavian artery (45.1% vs 34.4%; p = 0.029) were more common in the heart involvement group than patients without. Valvular abnormalities were found in 134 (81.7%) patients in the heart involvement group, myocardial abnormalities in 26 (15.9%), and coronary artery abnormalities in 19 patients (11.6%). The age at onset (yrs) and disease duration (mos) of patients with myocardial, valvular, and coronary arterial abnormalities were 18.8/13.0, 23.8/23.5, and 26.8/57.0, respectively. In the heart involvement group, 22 patients (84.6%) with myocardial abnormalities, 15 (78.9%) with coronary arterial abnormalities, and 89 (66.4%) with valvular abnormalities had Numano type V vessel involvement. The level of high-sensitivity C-reactive protein was higher in the heart involvement group (median: 10.0 mg/l), and the difference was significant when compared to the control group (median: 7.0 mg/l; p = 0.017).
CONCLUSION
Patients with TA complicated with cardiac abnormalities are not rare, especially in patients with Numano type V vessel involvement. We suggest that echocardiogram screening may be a helpful tool to understand the whole feature of patients with TA.
目的
了解中国 Takayasu 动脉炎（TA）患者心脏受累的特征。
方法
回顾性分析 411 例 TA 患者（325 例女性，86 例男性）的病历资料。比较有（n=164）和无（n=247）心脏受累的 TA 患者的临床表现。
结果
411 例 TA 患者的发病年龄中位数为 23.0 岁（18.0-30.0），164 例有心脏受累的患者为 23.0 岁（17.3-30.0）。心脏受累组的病程（中位数：24.0 个月）明显长于无心脏受累组（对照组，中位数：16.0 个月）。高血压（57.3% vs 46.6%；p=0.033）、肾功能不全（17.1% vs 7.7%；p=0.003）和锁骨下动脉杂音（45.1% vs 34.4%；p=0.029）在心脏受累组更为常见。心脏受累组 134 例（81.7%）患者存在瓣膜异常，26 例（15.9%）患者存在心肌异常，19 例（11.6%）患者存在冠状动脉异常。心肌、瓣膜和冠状动脉异常患者的发病年龄（岁）和病程（月）分别为 18.8/13.0、23.8/23.5 和 26.8/57.0。在心脏受累组中，22 例（84.6%）心肌异常、15 例（78.9%）冠状动脉异常和 89 例（66.4%）瓣膜异常患者均存在 Numano Ⅴ型血管受累。心脏受累组的高敏 C 反应蛋白水平较高（中位数：10.0 mg/l），与对照组（中位数：7.0 mg/l；p=0.017）比较差异有统计学意义。
结论
TA 合并心脏异常的患者并不少见，尤其是存在 Numano Ⅴ型血管受累的患者。我们建议超声心动图筛查可能是了解 TA 患者整体特征的有用工具。
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