摘要/Abstract

摘要： 目的·探讨体质量指数（body mass index，BMI）对系统性红斑狼疮（systemic lupus erythematosus，SLE）患者心肌累及的影响。方法·纳入2014年7月—2016年11月上海交通大学医学院附属仁济医院心内科收治的SLE患者61例，以及健康对照组54人。2组均进行心脏磁共振（cardiac magnetic resonance，CMR）及二维经胸超声心动图检查。将SLE患者根据BMI的四分位数分组，比较组间患者的CMR形态、功能及组织学指标。通过多因素线性回归分析研究SLE患者中BMI与细胞外容积分数（extracellular volume fraction，ECV）的关系。结果·校正年龄及疾病病程因素后，低BMI组（≤18.72 kg/m²）的ECV中位数较正常BMI组（18.73~23.00 kg/m²）及高BMI组（>23.00 kg/m²）显著升高（34.33% vs 30.52% vs 31.44%，P=0.007）。正常低值BMI组（18.73~20.20 kg/m²）的右室肥厚发生率（33.3%）、肺高血压发生率（26.7%）、心肌水肿发生率（6.7%），较低BMI组、正常高值BMI组（20.21~23.00 kg/m²）及高BMI组均更低。在长病程SLE患者中ECV与BMI存在显著相关性，当BMI≤23.00 kg/m²时为负相关（r=-0.597，P=0.009），当BMI>23.00 kg/m²时为正相关（r=0.739，P=0.023），但在健康对照组中左室射血分数、左室收缩末期容积及ECV与BMI均无线性相关关系。在多重线性回归校正年龄、免疫抑制剂使用及肺动脉压等因素后，SLE患者的BMI水平与ECV升高独立相关（BMI>23.00 kg/m²：β=-0.457，P=0.006。BMI≤23.00 kg/m²：β=0.766，P=0.001）。结论·SLE患者的心脏累及程度与BMI密切相关，对低BMI的SLE患者需要额外关注潜在的心肌损伤。将BMI维持于正常偏低水平（18.73~20.20 kg/m²）并避免超重（≤23.00 kg/m²）可能有助于患者的心肌保护。
关键词: 系统性红斑狼疮, 体质指数, 心脏磁共振, 细胞外容积分数
Abstract:
Objective·To explore the association between body mass index (BMI) and myocardial involvement in patients with systemic lupus erythematosus (SLE).
Methods·Fifty-four healthy participants and sixty-one patients with SLE who were admitted to the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine were prospectively recruited from July 2014 to November 2016 and then underwent cardiac magnetic resonance (CMR) and echocardiography examination. SLE patients were grouped according to the quartile of the BMI index, and then CMR morphology, function and histology indicators of each group were compared. The relationship between BMI and extracellular volume fraction (ECV) was explored by using multivariate linear analysis.
Results·Compared with normal BMI group (18.73?23.00 kg/m²) and high BMI group (>23.00 kg/m²), low BMI group (≤18.72 kg/m²) had higher median ECV (34.33% vs 30.52% vs 31.44%,P=0.007) after being adjusted for age and disease duration. The incidences of right ventricular hypertrophy (33.3%), pulmonary hypertension (26.7%) and edema (6.7%) were lower in low normal BMI group (18.73?20.20 kg/m²) than those in the low BMI group, high normal BMI group (20.21?23.00 kg/m²) and high BMI group. There was a strong correlation between BMI and ECV in long standing SLE patients. When BMI was less than 23.00 kg/m², it showed a negative correlation (r=-0.597, P=0.009), and a positive correlation (r=0.739, P=0.023) when over 23.00 kg/m². However, there was no significant correlation between ECV, left ventricular (LV) ejection fraction, LV end-systolic volume and BMI in control group. In the multivariable linear regression, BMI in patients with SLE was associated with elevated ECV independently after being adjusted for age, usage of immunosuppressor and pulmonary artery pressure (BMI>23.00 kg/m²: β=-0.457, P=0.006. BMI≤23.00 kg/m²: β=0.766, P=0.001).
Conclusion·Cardiac involvement in SLE is closely related to BMI. Low BMI patients should be careful with the cardiac injury. Maintaining BMI at normal low level (18.73?20.20 kg/m²) and avoiding overweight (≤23.00 kg/m²) may be necessary to myocardial protection.

Key words: systemic lupus erythematosus (SLE), body mass index (BMI), cardiac magnetic resonance (CMR), extracellular volume fraction (ECV)


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