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目的分析系统性硬化(systemic sclerosis,SSc)患者并发心血管损害(cardiovascular damage,CVD)的临床特点及相关因素。方法 110例SSc患者中,70例(63.6%)并发CVD者为并发CVD组,40例未并发CVD者为单纯SSc组;比较2组临床及实验室指标,观察SSc并发CVD患者的临床特征,分析其相关影响因素。结果并发CVD组患者发病年龄[(35±9)岁]小于单纯SSc组[(40±8)岁],病程[(6.0±3.3)a]长于单纯SSc组[(4.6±3.6)a],改良Rodnan皮肤硬化评分[(19.7±2.0)分]、血清胱抑素C水平[(1.36±0.17)mg/L]、总胆固醇[(4.9±2.3)mmol/L]、既往使用激素比例[(55±10)%]高于单纯SSc组[(15.9±2.2)分、(1.03±0.09)mg/L、(2.6±1.9)mmol/L、(30±8)%](P<0.05);并发CVD组患者常见损害为高脂血症、稳定性心绞痛和心律失常等,心电图异常以心律失常和心肌供血不足多见,心脏超声异常以心包积液多见;logistic回归分析显示,改良Rodnan皮肤硬化评分(OR=2.301,95%CI:2.066~2.794,P=0.007)、血清C反应蛋白(OR=2.003,95%CI:1.904~2.138,P=0.008)、总胆固醇(OR=1.485,95%CI:1.204~2.201,P=0.007)和胱抑素C(OR=2.001,95%CI:1.990~2.313,P=0.009)水平升高是SSc患者发生CVD的危险因素。结论 CVD为SSc患者常见临床特点;对改良Rodnan皮肤硬化评分、C反应蛋白、总胆固醇和血清胱抑素C水平升高的SSc患者,需高度警惕CVD的发生。
Objective To analyze the clinical features and related factors of cardiovascular damage (CVD) in patients with systemic sclerosis (SSc). Methods Seventy patients (63.6%) with concurrent CVD were complicated with CVD and 110 patients with SSc were simple SSc. The clinical and laboratory parameters of two groups were compared to observe the clinical features of patients with SSc complicated with CVD, Analysis of its related factors. Results The onset age of patients with concurrent CVD was smaller than that of patients with SSc [(40 ± 8) years old, (6.0 ± 3.3) years] [(4.6 ± 3.6) years] (19.7 ± 2.0) points for the improved Rodnan sclerosis score, serum cystatin C level (1.36 ± 0.17 mg / L) and total cholesterol (4.9 ± 2.3 mmol / L) 55 ± 10)%] was higher than that in SSc group [(15.9 ± 2.2), (1.03 ± 0.09) mg / L, (2.6 ± 1.9) mmol / L, Concurrent CVD patients with common lesions such as hyperlipidemia, stable angina pectoris and arrhythmia, ECG abnormal arrhythmia and myocardial insufficiency more common, abnormal cardiac ultrasound to pericardial effusion more common; logistic regression analysis showed that modified Rodnan skin (OR = 2.301, 95% CI: 2.066-2.794, P = 0.007), serum C-reactive protein (OR = 2.003, 95% CI: 1.904-2.1380, P = 0.008), total cholesterol % CI: 1.204-2.201, P = 0.007) and cystatin C (OR = 2.001, 95% CI: 1.990-2.313, P = 0.009) were the risk factors of CVD in patients with SSc. Conclusions CVD is a common clinical feature in patients with SSc. CVD patients with SSc who have improved Rodnan sclerosis score, C-reactive protein, total cholesterol and serum cystatin C levels should be highly vigilant against CVD.