From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India.
QJM. 2018 Feb 1;111(2):83-87. doi: 10.1093/qjmed/hcx195.
Cardiac tamponade is a rare but life-threatening complication of systemic lupus erythematosus (SLE).
AIMS/OBJECTIVES: To describe incidence, risk factors and treatment of cardiac tamponade in a large cohort of Indian patients with SLE.
This retrospective study was conducted at the Department of Rheumatology, IPGMER, Kolkata, India from May 2014 to December 2016 on admitted patients with SLE. Lupus-related serositis was diagnosed after excluding other causes, such as infection, malignancy or heart failure.
Of 409 patients with SLE, pericarditis was diagnosed in 25.4% (104/409) and cardiac tamponade in 5.9% (24/409). Tamponade was the presenting feature of SLE in 50% (12/24). Tamponade occurred in 77.8% (14/18) of large effusions and in 11.63% (10/86) of small-to-moderate effusions. The commonest autoantibody in serum and pericardial fluid was anti-nucleosme antibody. Large pericardial effusion (>20 mm) (Odd's ratio (OR): 93.2, 95% confidence interval (CI): 11.1-782.5, P < 0.001) predicted tamponade. In the subset of patients with small-to-moderate sized pericardial effusion, tamponade was associated with pleuritis (OR: 44.5, 95% CI: 1.6-1243, P = 0.025), anti-nucleosome antibody (OR: 42.9, 95% CI: 1.6-1176, P = 0.026) and size of pericardial effusion (OR: 1.36, 95% CI: 1.04-1.76, P = 0.025). Repeated pericardiocentesis was required in 3 patients and one needed surgical intervention. Immunosuppressives used were: prednisolone with monthly intravenous cyclophosphamide (in 33.33%) and intravenous methylprednisolone with monthly cyclophosphamide (in 50%).
Pleuritis, anti-nucleosome antibody and size of pericardial effusion predicted development of tamponade. High dose immunosuppression (methylprednisolone and IV cyclophosphamide) alleviated need for surgery in majority.
心脏压塞是系统性红斑狼疮（SLE）罕见但危及生命的并发症。
目的/目标：描述印度 SLE 患者大队列中心脏压塞的发生率、危险因素和治疗方法。
本回顾性研究于 2014 年 5 月至 2016 年 12 月在印度加尔各答的 IPGMER 风湿病科进行，纳入住院 SLE 患者。狼疮相关浆膜炎在排除其他原因（如感染、恶性肿瘤或心力衰竭）后诊断。
在 409 例 SLE 患者中，25.4%（104/409）诊断为心包炎，5.9%（24/409）诊断为心脏压塞。50%（12/24）的压塞为 SLE 的首发表现。压塞发生于 77.8%（14/18）大量心包积液和 11.63%（10/86）中小量心包积液中。血清和心包积液中最常见的自身抗体是抗核抗体。大心包积液（>20mm）（比值比（OR）：93.2，95%置信区间（CI）：11.1-782.5，P<0.001）预测压塞。在中小量心包积液的患者亚组中，压塞与胸膜炎（OR：44.5，95%CI：1.6-1243，P=0.025）、抗核小体抗体（OR：42.9，95%CI：1.6-1176，P=0.026）和心包积液量（OR：1.36，95%CI：1.04-1.76，P=0.025）相关。3 例患者需要反复心包穿刺，1 例需要手术干预。使用的免疫抑制剂为：泼尼松龙联合每月静脉环磷酰胺（33.33%）和静脉甲基泼尼松龙联合每月环磷酰胺（50%）。
胸膜炎、抗核小体抗体和心包积液量预测压塞的发生。大剂量免疫抑制（甲基泼尼松龙和 IV 环磷酰胺）缓解了大多数患者的手术需求。
