中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (5): 420-425.doi: 10.12007/j.issn.0258-4646.2018.05.009

• 论著 • 上一篇    下一篇

原发性干燥综合征患者合并肺动脉高压危险因素分析

李智腾, 范观止, 段培青, 张榕, 肖卫国   

  1. 中国医科大学附属第一医院风湿免疫科, 沈阳 110001
  • 收稿日期:2017-10-16 出版日期:2018-05-30 发布日期:2018-04-27
  • 通讯作者: 张榕 E-mail:zhangrong024@medmail.com.cn
  • 作者简介:李智腾(1991-),男,硕士研究生.
  • 基金资助:
    辽宁省科学技术计划(2012225097)

Analysis of the Risk Factors of Pulmonary Arterial Hypertension in Patients with Primary Sjögren's Syndrome

LI Zhiteng, FAN Guanzhi, DUAN Peiqing, ZHANG Rong, XIAO Weiguo   

  1. Department of Rheumatology, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2017-10-16 Online:2018-05-30 Published:2018-04-27

摘要: 目的 分析原发性干燥综合征(pSS)合并肺动脉高压(PAH)患者的临床特征,探讨pSS患者发生PAH的危险因素。方法 回顾性分析16例pSS合并PAH患者(pSS-PAH组)的临床资料、实验室相关指标、超声心动图等,与同期诊断的60例无PAH的pSS患者(pSS-non-PAH组)进行比较。结果 pSS-PAH组与pSS-non-PAH组比较,乳酸脱氢酶[(349.86±253.30) U/L vs (217.44±165.17) U/L]、谷草转氨酶[(41.50±34.37) U/L vs (24.61±18.68) U/L]、血清尿酸浓度[(374.20±128.26)μmol/L vs (292.13±244.64)μmol/L]、磷离子浓度[(1.30±0.13) mmol/L vs (1.16±0.18) mmol/L]、右心室内径[(28.69±9.33) mm vs (18.58±2.10) mm]、肺动脉内径[(28.19±5.09) mm vs (22.0±2.29) mm]均明显升高(P < 0.01,P < 0.05,P < 0.05,P < 0.01,P < 0.01,P < 0.01);而甲状腺激素T3水平[(3.24±0.90) pmol/L vs (3.97±0.68) pmol/L)]、血清镁离子浓度[(0.82±0.09) mmol/L vs (0.88±0.07) mmol/L]、左心室舒张末期内径[(40.50±6.70) mm vs (45.07±3.78) mm]、每搏量[(40.75±6.90) mL vs (51.32±11.57) mL]、左心室收缩末期容积[(21.94±5.90) mL vs (29.51±7.89) mL]、左心室舒张末期容积[(62.69±11.79) mL vs (80.76±17.93) mL]较pSS-non-PAH组降低(P < 0.01,P < 0.05,P < 0.05,P < 0.05,P < 0.01,P < 0.01)。logistic回归分析发现甲状腺素T3浓度降低、血清镁离子浓度降低、血清磷离子浓度升高是pSS合并PAH的危险因素(i>OR=0.251,P < 0.05;OR=0,P < 0.05;OR=2.088,P < 0.05)。结论 甲状腺素T3浓度降低、血清镁离子浓度降低、血清磷离子浓度升高或许是提示pSS患者发生PAH的血清学指标。

关键词: 干燥综合征, 肺动脉高压, 甲状腺素T3, 镁,

Abstract: Objective To investigate the clinical characteristics and risk factors of primary Sjögren's syndrome-associated pulmonary arterial hypertension(pSS-PAH).Methods The clinical data of 16 patients with pSS-PAH and 60 patients with pSS without PAH(pSSnon-PAH)were collected retrospectively. The t test,Mann-Whitney U test,chi-square test,and logistic regression analysis were used for statistical analysis of the laboratory index,echocardiographic data,and other related data.Results Compared with the pSS-non-PAH group,the pSS-PAH group had evidently increased lactate dehydrogenase(349.86 ±253.30 U/L vs 217.44 ±165.17 U/L),aspartate aminotransferase(41.50 ±34.37 U/L vs 24.61 ±18.68 U/L),serum uric acid(374.20 ±128.26 μmol/L vs 292.13 ±244.64 μmol/L), serum phosphorus(P)concentrations(1.30 ±0.13 mmol/L vs 1.16 ±0.18 mmol/L)right ventricular diameter(28.69 ±9.33 mm vs 18.58 ±2.10 mm),and pulmonary artery diameter(28.19 ±5.09 mm vs 22.0 ±2.29 mm;P < 0.01,<0.05,<0.05,<0.01,<0.01,and <0.01,respectively). However,the thyroid hormone T3(3.24 ±0.90 pmol/L vs 3.97 ±0.68 pmol/L)and serum magnesium(Mg)concentrations(0.82 ±0.09 mmol/L vs 0.88 ±0.07 mmol/L),left ventricular end-diastolic diameter(40.50 ±6.70 mm vs 45.07 ±3.78 mm),stroke volume(40.75±6.90 mL vs 51.32 ±11.57 mL),left ventricular end-systolic volume(21.94 ±5.90 mL vs 29.51 ±7.89 mL),and left ventricular end-diastolic volume(62.69 ±11.79 mL vs 80.76 ±17.93 mL)were lower in the pSS-PAH group than in the pSS-non-PAH group(P < 0.01,<0.05,<0.05,<0.05,<0.01,and <0.01,respectively). The logistic regression analysis revealed that reduced thyroid hormone T3 and serum Mg concentrations,and elevated serum P concentrations were the risk factors of pSS complicated with PAH(OR=0.251,P < 0.05;OR=0,P < 0.05;and OR=2.088,P < 0.05).Conclusion The reduced thyroid hormone T3 and serum Mg concentrations,and elevated serum P concentration may be the serological indicators to predict PAH in patients with pSS.

Key words: primary Sjögren's syndrome, pulmonary arterial hypertension, thyroid hormone T3, magnesium, phosphorus

中图分类号: 

  • R593.2
[1] DAFNI UG,TZIOUFAS AG,STAIKOS P,et al. Prevalence of Sjögren's syndrome in a closed rural community[J]. Annal Rheumat Dis,1997,56(9):521-525.
[2] KREIDER M,HIGHLAND K. Pulmonary involvement in Sjögren syndrome.[J]. Semin Respir Crit Care Med,2014,35(2):489-500. DOI:10.1055/s-0034-1371529.
[3] LAUNAY D,HACHULLA E,HATRON PY,et al. Pulmonary arterial hypertension:a rare complication of primary Sjögren syndrome:report of 9 new cases and review of the literature[J]. Medicine,2007,86(5):299-315. DOI:10.1097/MD.0b013e3181579781.
[4] MARVISI M,BALZARINI L,MANCINI C,et al. Thyroid gland and pulmonary hypertension. What's the link?[J]. Panminerva Med, 2013,55(1):93-97.
[5] VARGASURICOECHEA H,SIERRATORRES CH. Thyroid hormones and the heart[J]. Horm Mol Biol Clin Invest,2014,18(1):15-26. DOI:10.1515/hmbci-2013-0059.
[6] BADESCH DB,WYNNE KM,BONVALLET S,et al. Hypothyroidism and primary pulmonary hypertension:an autoimmune pathogenetic link?[J]. Ann Int Med,1993,119(1):44-46.
[7] CHU J W,KAO PN,FAUL JL,et al. High prevalence of autoimmune thyroid disease in pulmonary arterial hypertension[J]. Chest,2002, 122(5):1668-1673.
[8] WAJNER SM,GOEMANN IM,BUENO AL,et al. IL-6 promotes nonthyroidal illness syndrome by blocking thyroxine activation while promoting thyroid hormone inactivation in human cells[J]. J Clin Invest,2011,121(5):1834-1845. DOI:10.1172/JCI44678.
[9] KLEIN I,DANZI S. Cardiovascular involvement in general medical conditions thyroid disease and the heart[J]. Circulation,2007,116(15):1725-1735. DOI:10.1161/CIRCULATIONAHA.106.678326.
[10] DAHL P,DANZI S,KLEIN I. Thyrotoxic cardiac disease[J]. Curr Heart Fail Rep,2008,5(3):170-176.
[11] MALPUECHBRUGÈRE C,NOWACKI W,DAVEAU M,et al. Inflammatory response following acute magnesium deficiency in the rat[J]. Biochim Biophys Acta,2000,1501(2/3):91-98.
[12] WOLF FI,TRAPANI V,SIMONACCI M,et al. Magnesium deficiency and endothelial dysfunction:is oxidative stress involved?[J]. Magnes Res,2008,21(21):58-64.
[13] YOSHIMURA M,OSHIMA T,MATSUURA H,et al. Extracellular Mg2+ inhibit scapacitative Ca2+ entry in vascular smooth muscle cells[J]. Circulation,1997,95(11):2567-2572.
[14] TATSUMOTO N,YAMADA S,TOKUMOTO M,et al. Spironolactone ameliorates arterial medial calcification in uremic rats:the role of mineralocorticoid receptor signaling in vascular calcification[J]. Am J Physiol Renal Physiol,2015,309(11):F967-F979. DOI:10.1152/ajprenal.00669.2014.
[15] CHEN NX,MOE SM. Pathophysiology of vascular calcification[J]. Curr Osteoporos Rep,2015,13(6):372-380. DOI:10.1007/s11914-015-0293-9.
[16] SHUTO E,TAKETANI Y,TANAKA R,et al. Dietary phosphorus acutely impairs endothelial function[J]. J Am Soc Nephrol,2009,20(7):1504-1512. DOI:10.1681/ASN.2008101106.
[17] DIMARCO GS,HAUSBERG M,HILLEBRAND U,et al. Increased inorganic phosphate induces human endothelial cell apoptosis in vitro[J]. Am J Physiol Renal Physiol,2008,294(6):F1381-F387. DOI:10.1152/ajprenal.00003.2008.
[18] MARCO G SD,KÖNIG M,STOCK C,et al. High phosphate directly affects endothelial function by downregulating annexin Ⅱ[J]. Kidney Int,2013,83(2):213-222. DOI:10.1038/ki.2012.300.
[19] TROYANO N,NOGAL MD,MORA I,et al. Hyperphosphatemia induces cellular senescence in human aorta smooth muscle cells through integrin linked kinase(ILK)up-regulation[J]. Mech Ageing Dev,2015,152:43-55. DOI:10.1016/j.mad.2015.10.001.
[1] 郭镇豪, 吴泽扬, 李琦, 王晓凤, 陶维晨, 王聪, 赵敏. 兔血清对氧磷酶1对敌敌畏中毒大鼠大脑组织的保护作用[J]. 中国医科大学学报, 2018, 47(9): 778-782.
[2] 解丽丽, 吕洪涛, 许瑞雪. 磷酸化P38在神经病理性疼痛大鼠背根神经节中的作用机制[J]. 中国医科大学学报, 2018, 47(4): 308-311.
[3] 李丹妮, 刘云鹏. GATA1不同激酶活性突变体质粒的构建及蛋白表达和亚细胞定位[J]. 中国医科大学学报, 2018, 47(1): 22-26.
[4] 王聪,陶维晨,李琦,吴泽扬,郭镇豪,赵敏. 纯化兔血清对氧磷酶 1 与传统方法对敌敌畏所致大鼠 肝脏损伤的疗效比较[J]. 中国医科大学学报, 2017, 46(7): 582-586.
[5] 徐盟,费倩,孟潇,李金娜,张天翔,王颖. 多烯磷脂酰胆碱对奥沙利铂联合氟尿嘧啶所致荷瘤裸鼠 肝损伤的保护作用[J]. 中国医科大学学报, 2017, 46(6): 544-547.
[6] 张宝,孙磊,郑阳,姜洁璇,金镇. 性激素结合球蛋白、胰岛素信号转导蛋白和葡萄糖转运蛋白在 妊娠期糖尿病胎盘组织中的表达及相关性分析[J]. 中国医科大学学报, 2017, 46(2): 97-102.
[7] 徐平平, 倪莎, 周欣. 双特异性磷酸酶6在卵巢浆液性上皮肿瘤中的表达及临床意义[J]. 中国医科大学学报, 2017, 46(12): 1067-1070.
[8] 安朝旺,刘瑶,赵晓云,韩颖,赵雅宁,赵旭,李建民,薛承景. ERK1/2和PI3-K通路抑制剂对蛛网膜下腔出血大鼠海马区 神经细胞自噬的协同作用[J]. 中国医科大学学报, 2017, 46(11): 995-1000.
[9] 吴兵,刘晓伟,刘志. 氯解磷定不同用药方案对急性重度有机磷中毒的疗效比较[J]. 中国医科大学学报, 2017, 46(10): 949-951.
[10] 郭向飞 ,赵雅宁 ,李建民 ,刘文倩 ,陈长香. PI3K/mTOR/自噬通路在间歇性低氧加重全脑缺血大鼠神经损伤中的作用[J]. 中国医科大学学报, 2017, 46(1): 62-67.
[11] 任毅行,谷天祥. 右心衰竭三尖瓣返流伴肺动脉高压患者行 redo 手术的临床分析[J]. 中国医科大学学报, 2016, 45(8): 754-755.
[12] 张震 ,王学梅 ,徐克. LY294002 联合姜黄素对人肾癌细胞的体外抑制作用[J]. 中国医科大学学报, 2016, 45(6): 491-493.
[13] 阙雪莹,肖卫国. 124 例干燥综合征合并肺间质病变患者的临床分析[J]. 中国医科大学学报, 2016, 45(6): 546-549.
[14] 王微,刘建华,王桂丽,齐特,阮强,孙峥嵘. 人乳头瘤病毒 16 型甲基化水平与子宫颈病变程度关系的研究[J]. 中国医科大学学报, 2016, 45(4): 293-297.
[15] 张帆,韩新飞,张娜,张鹏思,赵敏. 重组人对氧磷酶1K192亚型对毒死蜱所致SD大鼠急性肝损伤的保护作用[J]. 中国医科大学学报, 2016, 45(2): 101-105.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA