Galve E, Candell-Riera J, Pigrau C, Permanyer-Miralda G, Garcia-Del-Castillo H, Soler-Soler J
Servicio de Cardiología, Hospital General Vall d'Hebron, Barcelona, Spain.
N Engl J Med. 1988 Sep 29;319(13):817-23. doi: 10.1056/NEJM198809293191302.
We performed echocardiography prospectively 4.9 +/- 0.7 years apart (mean +/- SD), in 74 patients with systemic lupus erythematosus. On the basis of the first study, the patients were distributed in four groups according to the type of valvular involvement: 7 patients had vegetations (Libman-Sacks endocarditis; group 1); 6 patients had rigid and thickened valves with stenosis, regurgitation, or both (group 2); 5 patients had miscellaneous forms of valvular involvement without valvular dysfunction (group 3), as did the 60 controls; and 56 patients had no valvular disease (group 4). The overall prevalence of clinically important valvular disease (groups 1 and 2) was 18 percent. Patients in group 1 were younger than those in group 2 (33.5 +/- 16.7 vs. 47.8 +/- 17.6 years; P less than 0.05), had a shorter mean duration of lupus (4.8 +/- 2.2 vs. 10.7 +/- 6.4 years; P less than 0.001), and had received a smaller cumulative dose of steroids (21.5 +/- 13.1 vs. 79.5 +/- 63.4 g of methylprednisolone or its equivalent; P less than 0.05). During the five-year follow-up, one patient in group 1 and five in group 2 required valve surgery, no patient in group 3 had valvular dysfunction, and five patients in group 4 had mild valvular lesions. We conclude that clinically important valvular involvement in systemic lupus is relatively frequent and sometimes requires surgery. Echocardiography can identify a subset of lesions (valvular thickening and dysfunction), other than verrucous (Libman-Sacks) endocarditis, that are prone to hemodynamic deterioration.
我们对74例系统性红斑狼疮患者进行了前瞻性超声心动图检查，检查间隔时间为4.9±0.7年（均值±标准差）。根据首次研究结果，患者根据瓣膜受累类型分为四组：7例有赘生物（Libman-Sacks心内膜炎；第1组）；6例瓣膜僵硬增厚，伴有狭窄、反流或两者皆有（第2组）；5例有其他形式的瓣膜受累但无瓣膜功能障碍（第3组），60例对照者也属于此类；56例无瓣膜疾病（第4组）。具有临床意义的瓣膜疾病（第1组和第2组）的总体患病率为18%。第1组患者比第2组患者年轻（33.5±16.7岁对47.8±17.6岁；P<0.05），狼疮平均病程较短（4.8±2.2年对10.7±6.4年；P<0.001），接受的类固醇累积剂量较小（21.5±13.1克甲基泼尼松龙或其等效物对79.5±63.4克；P<0.05）。在五年随访期间，第1组有1例患者、第2组有5例患者需要进行瓣膜手术，第3组无患者出现瓣膜功能障碍，第4组有5例患者有轻度瓣膜病变。我们得出结论，系统性红斑狼疮中具有临床意义的瓣膜受累相对常见，有时需要手术治疗。超声心动图可以识别除疣状（Libman-Sacks）心内膜炎之外的易发生血流动力学恶化的病变子集（瓣膜增厚和功能障碍）。
