CARDIAC ABNORMALITIES IN SYSTEMIC LUPUS-ERYTHEMATOSUS - ASSOCIATION WITH RAISED ANTICARDIOLIPIN ANTIBODIES
CARDIAC ABNORMALITIES IN SYSTEMIC LUPUS-ERYTHEMATOSUS - ASSOCIATION WITH RAISED ANTICARDIOLIPIN ANTIBODIES
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DOI：
10.1161/01.cir.82.2.369
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发表时间：
1990-08-01
期刊：
影响因子：
37.8
通讯作者：
OAKLEY, CM
中科院分区：
文献类型：
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作者：
NIHOYANNOPOULOS, P;GOMEZ, PM;OAKLEY, CM
对93例系统性红斑狼疮（SLE）患者进行了前瞻性二维超声心动图研究，以发现心脏异常的发生率和频谱，并将这些发现与高水平抗心磷脂抗体的存在相关。另外12例抗心磷脂抗体水平升高但无SLE的患者也进行了心内解剖评估。50%（54%）的系统性红斑狼疮患者出现心脏异常，43%（46%）的患者心脏正常。心脏异常分为三类：28%的患者存在瓣膜病变（从赘生物到瓣膜增厚），20%的患者存在心包积液或增厚，5%的患者存在局部或整体左心室功能障碍。50例SLE患者（54%）检测到高水平的抗心磷脂抗体。其中，只有11例（22%）心脏完全正常，而其余39例（78%）至少有一种心脏异常（20例瓣膜病变，15例心包积液，5例心肌功能障碍）。在SLE患者中，心内解剖结构异常与抗心磷脂抗体水平升高密切相关（p < 0.0001）。高水平抗心磷脂抗体预测心脏异常的总体敏感性和特异性分别为78%和74%，阳性预测准确率为78%，阴性预测准确率为74%。12例抗心磷脂抗体升高但不符合美国风湿病协会SLE分类标准的患者中，有8例（67%）心脏异常与SLE患者相似，而只有4例（33%）心脏正常（p < 0.001）。高水平的抗心磷脂抗体与心脏异常密切相关（p < 0.0001），不仅在SLE中，而且在其他狼疮样综合征中也是如此。
Two-dimensional echocardiographic studies were prospectively performed in 93 patients with systemic lupus erythematosus (SLE) to discover the incidence and spectrum of cardiac abnormalities and to relate these findings to the presence of high levels of anticardiolipin antibodies. Assessment of the intracardiac anatomy was also performed in an additional 12 patients who had increased anticardiolipin antibody levels but did not have SLE. FIfty patients (54%) with SLE had cardiac abnormalities, and 43 patients (46%) had normal hearts. Three categories of cardiac abnormalities were identified.sbd.valvular lesions, ranging from vegetations to valvular thickening, were found in 28%, pericardial effusion or thickening was found in 20%, and regional or global left ventricular dysfunction was found in 5%. High levels of anticardiolipin antibodies were detected in 50 patients (54%) with SLE. Of those, only 11 (22%) had an entirely normal heart, whereas the remaining 39 (78%) had at least one cardiac abnormality (valvular lesions in 20, pericardial effusion in 15, and myocardial dysfunction in five patients). In patients with SLE, the presence of abnormal intracardiac anatomy was strongly associated with increased levels of anticardiolipin antibodies (p < 0.0001). The overall sensitivity and specificity of high levels of anticardiolipin antibodies in the prediction of cardiac abnormalities was 78% and 74%, respectively, with a positive predictive accuracy of 78% and a negative predictive accuracy of 74%. Eight of the 12 patients (67%) who had increased anticardiolipin antibodies but whose disease did not fulfill the American Rheumatism Association classification criteria for SLE had cardiac abnormalities similar to those in patients with SLE compared with only four (33%) who had normal hearts (p < 0.001). High levels of anticardiolipin antibodies are strongly associated (p < 0.0001) with cardiac abnormalities, not only in SLE but also in other lupuslike syndromes.