郭潇潇,田庄,刘永太,赖晋智,王辉,赵久良,王迁,李梦涛,曾小峰,方理刚,张抒扬

• 1:中国医学科学院北京协和医学院北京协和医院心内科
• 2:中国医学科学院北京协和医学院北京协和医院风湿免疫科

摘要(Abstract)：

目的探讨系统性红斑狼疮(SLE)相关肺动脉高压(PAH)患者长期抗凝治疗对临床转归的影响。方法回顾性分析2010年2月至2016年12月北京协和医院收治的确诊SLE同时经右心导管明确诊断PAH患者的临床资料、治疗和转归情况。根据抗凝情况,分为抗凝组40例和未抗凝组70例,通过生存分析比较接受长期抗凝治疗与否对预后的影响。结果共分析110例SLE相关PAH患者,平均年龄(33.6±8.6)岁;其中40例(36.4%)接受抗凝治疗,抗凝药物均为华法林,中位抗凝时间13(6,28.3)个月。抗凝组肺循环阻力[(12.00±5.71)WU比(9.62±4.98)WU,P=0.027]、起始PAH靶向治疗比例(90.0%比54.2%,P<0.001)显著高于未抗凝组,差异均有统计学意义。抗凝组1年和3年生存率与未抗凝组比较,差异无统计学意义(P=0.825)。进一步的配对分析仍未显示抗凝组与未抗凝组间1年和3年估计生存率存在差异(P=0.234)。Cox多因素回归分析发现6 min步行距离(HR 0.993,95%CI 0.988～0.997,P<0.001)和起始PAH靶向治疗(HR0.252,95%CI 0.095～0.668,P=0.006)是患者全因死亡的独立预测因素,而是否接受抗凝治疗与全因死亡无关。结论 SLE相关PAH患者应用抗凝治疗不能改善预后。6 min步行距离和起始PAH靶向治疗是SLE相关PAH患者预后的独立预测因素。

关键词(KeyWords)： 系统性红斑狼疮;肺动脉高压;抗凝治疗

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院医学与健康科技创新工程项目（2018-I2M-1-001、2016-I2M-3-011、2016-I2M-4-003和2017-I2M-3-008）;; 国家自然科学基金(81500306)

作者(Author): 郭潇潇,田庄,刘永太,赖晋智,王辉,赵久良,王迁,李梦涛,曾小峰,方理刚,张抒扬

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