狼疮性肾炎伴狼疮心肌炎的临床及心脏磁共振特征

doi:10.3969/j.issn.1006-298X.2020.04.001

肾脏病与透析肾移植杂志

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狼疮性肾炎伴狼疮心肌炎的临床及心脏磁共振特征

出版日期:2020-08-28 发布日期:2020-08-22

Clinical and cardiac magnetic resonance features in lupus nephritis patients wtih lupus myocarditis#br#

Online:2020-08-28 Published:2020-08-22

摘要/Abstract

摘要： 目的：探讨狼疮性肾炎（LN）伴狼疮心肌炎（LM）患者的临床特征、预后及心脏磁共振（CMR）在LM诊断中的应用。
方法：2016年10月至2019年3月LM伴LN患者66例，其中女性61例、男性5例，中位年龄29（21，39）岁。LM诊断依据临床表现、心电图（EKG）、肌钙蛋白和超声心动图（UCG），或CMR符合LakeLouise标准；或CMR纵向弛豫时间定量成像（T1Mapping）技术T1值＞1 370 ms，并排除其他病因引起的心肌损伤。分析患者肾脏和心脏损伤的临床表现、治疗和预后，探讨CMR在LM诊断中的应用。
结果：55例（833%）存在急性肾损伤（AKI），42例（636%）需要肾脏替代治疗，肾活检病理以Ⅳ型和Ⅳ+Ⅴ型为主（39/46，848%），24例（522%）合并血栓性微血管病，22例（333%）以LM为首发症状，心脏损伤以呼吸困难最为常见（758%），其次为心悸（273%）和胸痛（106%），15例无症状。59例（894%）血NTproBNP升高，15例（227%）肌钙蛋白升高。41例（621%）符合UCG的LM诊断标准[左心室增大32例（485%）、心室壁增厚15例（227%）、室壁运动异常14例（212%）]。63例行CMR检查，31例（492%）符合LakeLouise LM标准，49例（778%）符合T1 Mapping LM诊断。15例无症状心肌炎患者中11例（733%）符合T1 Mapping LM诊断。合并AKI的LM患者心脏损伤指标更为严重。60例行甲泼尼龙静脉冲击，24例接受丙种球蛋白和血浆置换治疗。中位随访75个月，仅21例（50%）摆脱透析，2例死于感染，4例转为慢性心功能不全。
结论：合并AKI的LM患者心脏损伤指标更为严重，治疗后心脏损伤恢复较好，但肾脏预后差，需要早期诊断和积极治疗；应用CMR T1 Mapping技术可提高LM早期诊断的敏感性。

关键词: 狼疮心肌炎, 狼疮性肾炎, 心脏核磁共振, 纵向驰豫时间定量成像

Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the clinical manifestations and prognosis of patients with lupus nephritis (LN) and lupus myocarditis (LM), and properties of cardiac magnetic resonance (CMR).
Ｍｅｔｈｏｄｏｌｏｇｙ：Sixtysix patients, 61 women and 5 men, with a median onset age of 29 (21,39) years,were diagnosed with LN and LM from October 2016 to March 2019. The diagnosis for LM was based on clinical manifestations, EKG, troponin and ultrasonic cardiogram (UCG), or CMR. Clinical manifestations and prognosis of patients with LN and LM were studied, and the application of CMR in LM early diagnosis was evaluated.
Ｒｅｓｕｌｔｓ：55(833%) suffered form AKI, 42(636%) needed renal replacement therapy.46 underwent renal biopsy, 39 showed LN class Ⅳ or Ⅳ+Ⅴ. 24 (522%) biopsy showed thrombotic microangiopathy. 22(333%) of them had LM as their initial presentation of Systemic Lupus Erythematosus. Symptoms of myocarditis consisted of dyspnea(758%), palpitation(273%) and chest pain(106%) . NTproBNP and troponin were increased in 59(894%) and 15(227%) patients. UCG showed left ventricular enlargement in 32(485%), ventricular wall thickening in 15(227%), abnormal left ventricular wall motion in 14(212%), 41(621%) met UCG criteria. 63 underwent CMR, 31(492%) met the LakeLouise criteria. T1 values＞1 370 ms in 49(778%) patients. Indicators of cardiac injury were more serious in LM patients with AKI.60 cases received methylprednisolone venous therapy, 24 received gamma globulin and dual plasmaphermoplasty. After median followup of 75 months, only 21(500%) patients weaned of dialysis, 2 patients died of infection. 4 cases progressed to chronic cardiac insufficiency.
Ｃｏｎｃｌｕｓｉｏｎ：
LM patients with AKI had more serious damage of heart function.Compare to the poor renal prognosis, most of LM patients recovered from heart injury after treatment.Application of CMR T1Mapping can improve sensitivity of LM early diagnosis

Key words: lupus myocarditis, lupus nephritis, cardiac magnetic resonance, T1-Mapping

董建华，罗松，许书添，等. 狼疮性肾炎伴狼疮心肌炎的临床及心脏磁共振特征[J]. 肾脏病与透析肾移植杂志, DOI: 10.3969/j.issn.1006-298X.2020.04.001.

ONG Jianhua,LUO Song,XU Shutian, et al . Clinical and cardiac magnetic resonance features in lupus nephritis patients wtih lupus myocarditis#br#[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, DOI: 10.3969/j.issn.1006-298X.2020.04.001.

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ISSN 1006-298X CN 32-1425/R

狼疮性肾炎伴狼疮心肌炎的临床及心脏磁共振特征

Clinical and cardiac magnetic resonance features in lupus nephritis patients wtih lupus myocarditis#br#

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