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[原发性干燥综合征相关肺动脉高压:20例新病例]

[Primary Sjogren's syndrome associated pulmonary arterial hypertension: 20 new cases].

作者信息

Zhao Y, Wang H, Chen M, Zhang N, Yang Z W, Li D, Wei W

机构信息

Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin 300052, China.

Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 Oct 8;99(37):2921-2925. doi: 10.3760/cma.j.issn.0376-2491.2019.37.010.

Abstract

To describe baseline characteristics of patients with primary Sjogren's syndrome (pSS) with right heart catheterization (RHC)-confirmed pulmonary arterial hypertension (PAH). This retrospective study included consecutive patients hospitalized with pSS-PAH from Jan.2013 to June.2019 in Tianjin Medical University General Hospital. All patients fulfilled the 2002 revised criteria for pSS proposed by the American-European Consensus Group. PAH was defined according to RHC-based European Society of Cardiology/European Respiratory Society guidelines. Associated variables were described and analyzed. Predictive factors for achieving treatment goals were explored. Sub-groups(based on Anti-SSB antibody positive/negative) were analyzed. Twenty patients with RHC-confirmed pSS-PAH were included (median age at onset, 54.5 years; median PAH duration, 12 months).PAH was the initial manifestation of pSS in 5 patients(26.3%), and shortness of breath was the most common symptom (17/20,85%). Mean pulmonary arterialpressure (mPAP) was 48(38, 55.75)mmHg, pulmonary vascularresistance (PVR) was 11.23 (6.17,14.69)IU, and mean cardiac index was 2.59(2.04,2.98)L·min(-1)·m(-2) in this group. In addition, right ventricular diameter≤40 mm[0.009, =5.92, 95(1.55, 22.59)] was predictive factor for achieving the treatment goal. Furthermore, compared with Anti-SSB antibody negative patients, patients with Anti-SSB antibody positive had a higher PVR(IU) [14.1(11.23, 22.63)vs 6.4(6.15, 12.36),0.025], a higher mPAP(mmHg)[5(48.5,59)vs 39(32.5,50.75),0.013], and a lower cardiac index (L·min(-1)·m(-2)) [2.1(1.6,2.5)vs 2.9(2.56,3.41),0.002]. pSS-PAH patients are mainly middle-aged women with the most common symptom shortness of breath. And PAH can be the first manifestation of pSS. More attention should be paid to patients with Anti-La/SSB antibody positive and right ventricular diameter ≤40 mm because of higher mPAP, PVR, worse cardiac function and prognosis.

摘要

描述经右心导管检查(RHC)确诊为肺动脉高压(PAH)的原发性干燥综合征(pSS)患者的基线特征。这项回顾性研究纳入了2013年1月至2019年6月在天津医科大学总医院因pSS-PAH住院的连续患者。所有患者均符合美国-欧洲共识小组2002年修订的pSS标准。PAH根据基于RHC的欧洲心脏病学会/欧洲呼吸学会指南进行定义。对相关变量进行描述和分析。探索实现治疗目标的预测因素。对亚组(基于抗SSB抗体阳性/阴性)进行分析。纳入了20例经RHC确诊的pSS-PAH患者(发病时中位年龄54.5岁;PAH中位病程12个月)。5例患者(26.3%)中PAH是pSS的初始表现,气短是最常见症状(17/20,85%)。该组平均肺动脉压(mPAP)为48(38,55.75)mmHg,肺血管阻力(PVR)为11.23(6.17,14.69)IU,平均心脏指数为2.59(2.04,2.98)L·min⁻¹·m⁻²。此外,右心室直径≤40 mm[0.009,χ² =5.92,95%CI(1.55,22.59)]是实现治疗目标的预测因素。此外,与抗SSB抗体阴性患者相比,抗SSB抗体阳性患者的PVR(IU)更高[14.1(11.23,22.63)对6.4(6.15,12.36),P = ~0.025],mPAP(mmHg)更高[5(48.5,59)对39(32.5,50.75),P = ~0.013],心脏指数(L·min⁻¹·m⁻²)更低[2.1(1.6,2.5)对2.9(2.56,3.41),P = ~0.002]。pSS-PAH患者主要为中年女性,最常见症状为气短。且PAH可为pSS的首发表现。对于抗La/SSB抗体阳性且右心室直径≤40 mm的患者应给予更多关注,因其mPAP、PVR更高,心功能及预后更差。 (注:原文部分统计数据后的括号内格式有些混乱,这里尽量按合理理解翻译并标注了可能的格式问题。)

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