紅斑性狼瘡患者合併冠狀動脈心臟疾病或肺動脈高壓的特徵差異──單一醫學中心回溯性研究

Differences between Coronary Artery Disease and Pulmonary Arterial Hypertension in Patients with Systemic Lupus Erythematosus--A Single-Center Retrospective Study

目的：比較紅斑性狼瘡患者合併冠狀動脈心臟疾病或肺動脈高壓的特徵差異。方法：針對單一醫學中心，回顧2006－2017期間持有重大傷病卡或符合SLICC 2012分類標準的紅斑性狼瘡患者接受血管攝影的病歷紀錄。當中針對有確切冠狀動脈心臟疾病或肺動脈高壓診斷的患者進行收案，並做更進一步的分析研究。結果：總計回顧5388名紅斑性狼瘡患者，其中69名患者有接受過血管攝影。經血管攝影後，有確切且初次診斷冠狀動脈心臟疾病的患者為30名，有明確WHO group 1的肺高壓患者為10名。相較於肺高壓，罹患冠狀動脈心臟疾病的紅斑性狼瘡患者的年紀較大（60.5歲vs.39歲）、罹患紅斑性狼瘡的時間較長（19.2年vs.6年）、有較高的BMI（23.3 vs. 20.8）、有較多人罹患高血壓（21／30 vs.0）和末期腎臟疾病（10／30 vs. 0）。罹患肺高壓的患者則在anti-Sm和anti-SSA有較高比例呈現陽性。在預後部分，冠狀動脈心臟疾病患者的五年存活率則較肺高壓患者為佳（77.6％vs. 20.8%）。結論：和合併肺高壓的患者相比，紅斑性狼瘡合併冠狀動脈心臟疾病患者的年紀較大、罹患紅斑性狼瘡的期間較長、BMI較高、有較高比例合併高血壓與末期腎臟疾病，且五年存活率較佳。紅斑性狼瘡合併肺高壓的患者則出現anti-Sm和anti-SSA的比例較高。

Objective: To compare the characteristics and prognoses of coronary artery disease (CAD) and pulmonary arterial hypertension (PAH) among patients with systemic lupus erythematosus (SLE) Methods: This retrospective cohort study was conducted by reviewing patient medical records. The following inclusion criteria were used: patients who underwent angiography during 2006-2017 and were registered as having SLE in the catastrophic illness database or those who fulfilled the 2012 Systemic Lupus International Collaborating Clinics criteria. Patients with angiographic diagnoses of CAD and PAH were analyzed. Results: There were 5388 patients with SLE screened, and 69 patients undergoing angiography were enrolled. Thirty patients had newly diagnosed CAD, and 10 patients were classified as WHO Group 1 PAH. Compared with the PAH group, patients in the CAD group had older age (60.5 years vs. 39 years), longer time since diagnosis with SLE (19.2 years vs. 6 years), higher BMI (23.3 vs. 20.8), more hypertension (21/30 vs. 0) and end-stage renal disease (10/30 vs. 0). Patients in the PAH group had morepositive results of anti-Sm and anti-SSA than those in the CAD group. The five-year survival of CAD patients was better than PAH patients (77.6% vs. 20.8%). Conclusions: Compared with SLE-PAH patients, SLE-CAD patients have older age, longer time since diagnosis with SLE, higher BMI, more hypertension and end-stage renal disease, and better five-year survival. The PAH group has higher levels of anti-Sm and anti-SSA than the CAD group.