抗磷脂抗体对系统性红斑狼疮心脏瓣膜受累的影响：基于中国系统性红斑狼疮研究协作组（CSTAR）队列研究

Impact of antiphospholipid antibodies on heart valve involvements in systemic lupus erythematosus: based on CSTAR cohort.

作者信息

Chen Siyun, Huang Can, Jiang Hui, Zhou Yangzhong, Peng Liying, Wang Ziqian, Qian Junyan, Bai Wei, Zhang Shangzhu, Wang Chuhan, Zhao Yuan, Guo Xiaoxiao, Li Mengtao, Zeng Xiaofeng, Zhao Jiuliang, Zhao Yan

机构信息

Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology, Beijing, China.

State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.

出版信息

Lupus Sci Med. 2025 Jun 19;12(1):e001674. doi: 10.1136/lupus-2025-001674.

DOI:10.1136/lupus-2025-001674

PMID:40541268

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12182168/

Abstract

OBJECTIVE

This study aims to evaluate the role of antiphospholipid antibodies (aPLs) in patients with SLE with heart valve diseases (HVDs).

METHODS

This prospective study included consecutive patients with SLE who visited Peking Union Medical College Hospital between April 1999 and December 2024. Echocardiography was performed based on clinical indications. Clinical characteristics, aPL profiles and echocardiographic findings were collected. Logistic regression was used to evaluate associations between aPLs and HVD.

RESULTS

Among 508 patients with SLE, 27.4% had HVD. The most frequently affected valves were aortic (17.3%) and mitral (11.2%) valves, with thickening (19.5%) and regurgitation (15.9%) as the leading lesion types. aPLs positive patients with SLE had higher rates of HVD (35.1% vs 24.0%, p=0.010), including valve thickening (25.3% vs 16.9%, p=0.028), regurgitation (24.7% vs 12.1%, p<0.001), vegetations (9.1% vs 0.8%, p<0.001) and stenosis (1.9% vs 0.0%, p=0.008). Anticardiolipin-IgG was associated with HVD (OR=2.484, p=0.003), mitral lesions (OR=4.156, p<0.001), valve thickening (OR=2.255, p=0.011) and regurgitation (OR=2.121, p=0.014). Anti-β2 glycoprotein I-IgG showed similar associations and was also linked to valve stenosis (OR=11.209, p=0.022). Lupus anticoagulant (LA) was associated with valve vegetations (OR=8.659, p<0.001) and interventional/surgical indications (OR=6.868, p=0.005).

CONCLUSION

aPLs, especially IgG isotype and LA, are independently associated with diverse HVD in SLE. Echocardiographic monitoring is warranted in aPL-positive patients.

摘要

目的

本研究旨在评估抗磷脂抗体（aPLs）在患有心脏瓣膜疾病（HVDs）的系统性红斑狼疮（SLE）患者中的作用。

方法

这项前瞻性研究纳入了1999年4月至2024年12月期间在北京协和医院就诊的连续SLE患者。根据临床指征进行超声心动图检查。收集临床特征、aPL谱和超声心动图检查结果。采用逻辑回归评估aPLs与HVD之间的关联。

结果

在508例SLE患者中，27.4%患有HVD。最常受累的瓣膜是主动脉瓣（17.3%）和二尖瓣（11.2%），主要病变类型为增厚（19.5%）和反流（15.9%）。aPLs阳性的SLE患者HVD发生率更高（35.1%对24.0%，p=0.010），包括瓣膜增厚（25.3%对16.9%，p=0.028）、反流（24.7%对12.1%，p<0.001）、赘生物（9.1%对0.8%，p<0.001）和狭窄（1.9%对0.0%，p=0.008）。抗心磷脂IgG与HVD相关（OR=2.484，p=0.003）、二尖瓣病变（OR=4.156，p<0.001）、瓣膜增厚（OR=2.255，p=0.011）和反流（OR=2.121，p=0.014）。抗β2糖蛋白I-IgG显示出类似的关联，并且还与瓣膜狭窄相关（OR=11.209，p=0.022）。狼疮抗凝物（LA）与瓣膜赘生物（OR=8.659，p<0.001）和介入/手术指征相关（OR=6.868，p=0.005）。