Cardiac Involvement In Newly Diagnosed Systemic Lupus Erythematosus:A Clinical Analysis

Background:Systemic lupus erythematosus((SLE))is a diffuse connective tissue disease with multiple organs and systems involved.Cardiac involvement is a common com-plication,after infection and renal failure which is the third cause of death.The clinical phenotype of SLE is complex and the pathogenesis is not fully elucidated.Cardiac involvement in SLE may be related to many factors,such as immune abnormality,endocrine,heredity,infection,traditional risk factors,drug treatment and so on.Due to the atypical clinical symptoms in the early stage of heart damage,it is easy to be ignored.In order to reduce the misdiagnosis rate and incidence of cardiac involvement,and improve the long-term prognosis of patients.It is necessary to study the clinical data of patients with SLE newly diagnosed without drug treatment,in order to explore the mechanism of early occurrence of cardiac damage in SLE and the characteristics of changes in various indexes.Objective:To retrospectively analyze the clinical data and laboratory data of newly diagnosed SLE patients,understand the clinical characteristics of newly diagnosed SLE complicated with cardiac involvement,and further improve the understanding of newly diagnosed SLE cardiac involvement.The multiple factors of cardiac involvement in SLE were discussed in order to provide basis for early detection,early diagnosis and early treatment.Methods:This retrospective study included 74 patients who were newly diagnosed with systemic lupus erythematosus from J January 2012 to December 2017 in the first Affiliated Hospital of Jinan University.The case-control study was to collect general data,laboratory examination,electrocardiogram and echocardiography,to evaluate whether there was cardiac function and structure involvement.The patients were divided into non-cardiac involvement group(Non-CI group)and cardiac involvement group(CI group),the differences of various indexes between the two groups were compared,and the statistically significant parameters in univariate analysis were analyzed by multivariate regression analysis.Results:1.The manifestations of cardiac involvement in patients with newly diagnosed SLE included:the proportion of abnormal ECG was 67.65%,and T wave/ST-T changes were more common(50%).Echocardiographic abnormalities:pericardial effusion in 4 cases(11.76%),valvular regurgitation in 27 cases(79.41%),mitral valve degeneration in 3 cases(8.82%),aortic valve degeneration in 3 cases(8.82%),decreased left ventricular diastolic function in 24 cases(70.59%),interventricular septal thickening in 4 cases(11.76%),left atrial enlargement in 12 cases(35.29%),right atrial enlargement in 3 cases(8.82%),Pulmonary hypertension occurred in 2cases(5.88%).The levels of LA,IVS,LVPW and VA in the CI group were higher than those in the Non-CI group,while the levels of V_E,V_E/V_A and LVEF(%)in the CI group were lower than those in the Non-CI group.2.There was no statistical significance in all biochemical test indexes of two groups.There was a statistical difference in the distribution of 24-hour proteinuria between the two groups(P<0.05),and the level of the CI group was higher than that of the Non-CI group;compared with the immunologic indexes of the two groups,there was a statistical difference in the distribution of Ig G(P<0.05),and the median value of Ig G in two groups was abnormally increased(>16.2g/L),but the elevated level in the CI group was lower than that in the Non-CI group.The positive rates of anti-nucleosome antibody(Anu A),anti-Sm antibody and anti-SSA antibody were significantly different between the two groups.The positive rate of anti nucleosome antibody(Anua)and anti Sm antibody in the CI group was lower than that in the Non-CI group,and the positive rate of anti SSA antibody in the CI group was higher than that in the Non-CI group;there was no statistical difference in SLEDAI score classification between two groups(P>0.05).3.Logistics regression multivariate analysis showed that age,anti-Sm antibody and anti-SSA antibody were independent risk factors.Conclusions:1.Cardiac involvement is common in newly diagnosed SLE patients,and the clinical symptoms are mostly atypical.Echocardiography in patients with newly diagnosed SLE mostly showed LVEF and decreased left ventricular diastolic function.2.Cardiac involvement in newly diagnosed SLE patients is related to age,24-hour urinary protein,Ig G,Anu A,abnormal(or positive)rates of anti-Sm antibody and anti-SSA antibody.Patients with kidney involvement are more likely to have cardiac involvement.3.The independent risk factors of cardiac involvement in newly diagnosed SLE patients were age and increased positive rate of anti-SSA antibody.