体质量指数对系统性红斑狼疮患者心肌累及的影响

doi:10.3969/j.issn.1674-8115.2021.02.009

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (2): 180-186.doi: 10.3969/j.issn.1674-8115.2021.02.009

体质量指数对系统性红斑狼疮患者心肌累及的影响

冯泽豪(), 柴烨子, 苏璇, 孙宝航行, 刘启明, 姜萌(), 卜军()

上海交通大学医学院附属仁济医院心内科，上海 200127

收稿日期:2020-05-06 出版日期:2021-02-28 发布日期:2021-02-28
通讯作者: 姜萌,卜军 E-mail:fengzehao2016@126.com;jiangmeng0919@163.com;pujun310@hotmail.com
作者简介:冯泽豪（1994—），男，硕士生；电子信箱：fengzehao2016@126.com。
基金资助:
国家自然科学基金(81971570);上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(16CR3020A);上海市教育委员会高峰高原学科建设计划(20172014);上海市浦东新区卫生和计划生育委员会联合攻关项目(PW2018D-03);上海交通大学“交大之星”计划医工交叉研究基金(YG2019ZDA13)

Association between body mass index and myocardial involvements in patients with systemic lupus erythematosus

Ze-hao FENG(), Ye-zi CHAI, Xuan SU, Bao-hang-xing SUN, Qi-ming LIU, Meng JIANG(), Jun PU()

Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2020-05-06 Online:2021-02-28 Published:2021-02-28
Contact: Meng JIANG,Jun PU E-mail:fengzehao2016@126.com;jiangmeng0919@163.com;pujun310@hotmail.com
Supported by:
National Natural Science Foundation of China(81971570);Shanghai Shenkang Hospital Development Center Three-year Action Plan: Promoting Clinical Skills and Innovation in Municipal Hospital(16CR3020A);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20172014);Shanghai Pudong Municipal Health Commission-Joint Research Project(PW2018D-03);Medical-Engineering Cross Research Foundation of Shanghai Jiao Tong University(YG2019ZDA13)

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)

中图分类号:

R593.2

冯泽豪, 柴烨子, 苏璇, 孙宝航行, 刘启明, 姜萌, 卜军. 体质量指数对系统性红斑狼疮患者心肌累及的影响[J]. 上海交通大学学报(医学版), 2021, 41(2): 180-186.

Ze-hao FENG, Ye-zi CHAI, Xuan SU, Bao-hang-xing SUN, Qi-ming LIU, Meng JIANG, Jun PU. Association between body mass index and myocardial involvements in patients with systemic lupus erythematosus[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(2): 180-186.

图/表 7

参考文献 17

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Indicator	Control group (n=54)	SLE group (n=61)	P value
Age/year	30 (24, 49)	37 (28, 45)	0.324
Female/n (%)	43 (79.6)	56 (91.8)	0.842
BMI/ (kg·m^-2)	22.76 (21.04, 25.16)	20.20 (18.72, 23.00)	0.000
Clinical feature
Smoking/n (%)	2 (3.7)	1 (1.6)	0.915
Hypertension/n (%)	2 (3.7)	1 (1.6)	0.915
Disease duration/month	?	60 (24, 114)	?
New onset/n (%)	?	27 (44.3)	?
PAPm/mmHg	?	30 (21, 67)	?
Laboratory examination
Hematocrit/%	0.39 (0.36, 0.41)	0.34 (0.28, 0.40)	0.001
TnI/ (ng·mL^-1)	0 (0, 0.01)	0.01 (0.01, 0.03)	0.000
BNP/ (pg·mL^-1)	52 (26, 167)	280 (51, 809)	0.018
Cardiac function classification
NYHA Ⅲ?Ⅳ/n (%)	0 (0)	2 (3.3)	0.918
CCS Ⅲ?Ⅳ/n (%)	0 (0)	1 (1.6)	1.000
Other autoimmune disease
Sjogren's syndrome/n (%)	?	3 (5.9)	?
PH/n (%)	?	32 (52.5)	?
Hashimoto's thyroiditis/n (%)	?	1 (1.6)	?
Concurrent medicine in long-standing SLE
Prednisone/n (%)	?	31/34 (91.2)	?
Mycophenolate/n (%)	?	3/34 (8.8)	?
Cyclosporine/n (%)	?	2/34 (5.9)	?
Azathioprine/n (%)	?	1/34 (2.9)	?

Indicator	Control group (n=54)	SLE group (n=61)	P value
Age/year	30 (24, 49)	37 (28, 45)	0.324
Female/n (%)	43 (79.6)	56 (91.8)	0.842
BMI/ (kg·m^-2)	22.76 (21.04, 25.16)	20.20 (18.72, 23.00)	0.000
Clinical feature
Smoking/n (%)	2 (3.7)	1 (1.6)	0.915
Hypertension/n (%)	2 (3.7)	1 (1.6)	0.915
Disease duration/month	?	60 (24, 114)	?
New onset/n (%)	?	27 (44.3)	?
PAPm/mmHg	?	30 (21, 67)	?
Laboratory examination
Hematocrit/%	0.39 (0.36, 0.41)	0.34 (0.28, 0.40)	0.001
TnI/ (ng·mL^-1)	0 (0, 0.01)	0.01 (0.01, 0.03)	0.000
BNP/ (pg·mL^-1)	52 (26, 167)	280 (51, 809)	0.018
Cardiac function classification
NYHA Ⅲ?Ⅳ/n (%)	0 (0)	2 (3.3)	0.918
CCS Ⅲ?Ⅳ/n (%)	0 (0)	1 (1.6)	1.000
Other autoimmune disease
Sjogren's syndrome/n (%)	?	3 (5.9)	?
PH/n (%)	?	32 (52.5)	?
Hashimoto's thyroiditis/n (%)	?	1 (1.6)	?
Concurrent medicine in long-standing SLE
Prednisone/n (%)	?	31/34 (91.2)	?
Mycophenolate/n (%)	?	3/34 (8.8)	?
Cyclosporine/n (%)	?	2/34 (5.9)	?
Azathioprine/n (%)	?	1/34 (2.9)	?

Indicator	Control group （n=54）	SLE group （n=61）	P value
LVEF/%	67.60±6.62	63.02±10.48	0.006
LVEDV/mL	110.95 (98.58, 129.42)	109.20 (86.45, 131.18)	0.295
LVEDV/BSA/(mL·m^-2)	65.08 (61.01, 75.56)	69.71 (55.46, 80.33)	0.444
LVESV/mL	36.06 (27.57, 44.53)	35.50 (25.55, 49.65)	0.894
LVESV/BSA/(mL·m^-2)	20.51 (17.61, 25.94)	22.83 (17.42, 29.57)	0.214
LV mass/g	87.66 (73.98, 104.67)	110.45 (87.78, 123.23)	0.000
LV mass/BSA/(g·m^-2)	53.12 (46.26, 60.77)	67.14 (58.05, 81.82)	0.000
RVEF/%	61.72±8.45	50.13±11.33	0.000
RVEDV/mL	102.05 (84.08, 126.23)	114.80 (97.38, 135.93)	0.098
RVEDV/BSA/(mL·m^-2)	59.68 (50.98, 75.20)	71.44 (61.74, 91.83)	0.002
RVESV/mL	40.00 (29.23, 52.35)	55.25 (42.70, 73.60)	0.000
RVESV/BSA/(mL·m^-2)	23.00 (19.20, 30.86)	34.40 (27.12, 47.84)	0.000
LV native myocardial T1/ms	1 284.36±44.02	1 360.48±70.33	0.000
LV ECV/%	26.22±2.40	30.94±3.74	0.000

Indicator	Control group （n=54）	SLE group （n=61）	P value
LVEF/%	67.60±6.62	63.02±10.48	0.006
LVEDV/mL	110.95 (98.58, 129.42)	109.20 (86.45, 131.18)	0.295
LVEDV/BSA/(mL·m^-2)	65.08 (61.01, 75.56)	69.71 (55.46, 80.33)	0.444
LVESV/mL	36.06 (27.57, 44.53)	35.50 (25.55, 49.65)	0.894
LVESV/BSA/(mL·m^-2)	20.51 (17.61, 25.94)	22.83 (17.42, 29.57)	0.214
LV mass/g	87.66 (73.98, 104.67)	110.45 (87.78, 123.23)	0.000
LV mass/BSA/(g·m^-2)	53.12 (46.26, 60.77)	67.14 (58.05, 81.82)	0.000
RVEF/%	61.72±8.45	50.13±11.33	0.000
RVEDV/mL	102.05 (84.08, 126.23)	114.80 (97.38, 135.93)	0.098
RVEDV/BSA/(mL·m^-2)	59.68 (50.98, 75.20)	71.44 (61.74, 91.83)	0.002
RVESV/mL	40.00 (29.23, 52.35)	55.25 (42.70, 73.60)	0.000
RVESV/BSA/(mL·m^-2)	23.00 (19.20, 30.86)	34.40 (27.12, 47.84)	0.000
LV native myocardial T1/ms	1 284.36±44.02	1 360.48±70.33	0.000
LV ECV/%	26.22±2.40	30.94±3.74	0.000

Indicator	New onset SLE		P value	Long standing SLE		P value
Indicator	Active SLE (n=14)	Inactive SLE (n=13)	P value	Active SLE (n=17)	Inactive SLE (n=17)	P value
Age/year	22 (18, 31)	29 (21, 51)	0.089	32 (28, 47)	35 (24, 45)	0.704
Disease duration/month	0 (0, 1)	0 (0, 0)	0.505	60 (30, 66)	60 (30, 138)	0.327
BMI/(kg·m^-2)	19.45 (18.07, 20.75)	20.03 (18.28, 21.93)	0.627	21.37 (18.52, 24.40)	21.26 (19.24, 24.24)	0.890
CK-MB/(ng·mL^-1)	7.8 (1.0, 18.8)	0.7 (0.4, 1.1)	0.023	10.8 (5.8, 22.3)	2.2 (1.0, 12.0)	0.057
BNP/(pg·mL^-1)	127 (47, 692)	36 (13, 214)	0.043	300 (57, 958)	259 (34, 790)	0.538
TNI/(ng·mL^-1)	0.03 (0, 0.14)	0.01 (0, 0.01)	0.181	0.01 (0.01, 0.03)	0.01 (0.01, 0.05)	0.915
CMR
LVEF/%	66.70 (54.55, 70.35)	66.7 (60.8, 71.50)	0.608	67.90 (57.20, 74.75)	60.3 (53.7, 63.95)	0.121
LV ECV/%	29.46 (25.92, 36.16)	31.40 (28.89, 34.59)	0.594	30.67 (29.29, 34.44)	31.92 (30.57, 32.92)	0.306
LV native myocardial T1/ms	1 347 (1 280, 1 391)	1 325 (1 305, 1 448)	0.412	1 366 (1 347, 1 452)	1 370 (1 323, 1 408)	0.519
RVEF/%	56.20 (41.30, 64.90)	52.30 (43.20, 62.50)	0.700	50.40 (46.10, 57.70)	46.40 (34.75, 56.65)	0.256
Global radial strain
LV/%	42 (36, 50)	43 (34, 56)	0.568	36 (32, 50)	46 (37, 49)	0.484
RV/%	12 (9, 17)	24 (16, 31)	0.027	18 (16, 24)	16 (10, 33)	0.337

体质量指数对系统性红斑狼疮患者心肌累及的影响

Association between body mass index and myocardial involvements in patients with systemic lupus erythematosus

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Metrics

Indicator	Low BMI group （n=15）	Normal BMI group (n=31)	High BMI group (n=15)	Adjusted P value
Age/year	27 (20, 40)	34 (25, 47)	40 (25, 48)	0.117
Disease duration/month	4 (0, 60)	24 (0, 60)	60 (12, 60)	0.057
New onset/n (%)	8 (53.3)	17 (54.8)	2 (13.3)	0.021
Active SLE/n (%)	10 (66.7)	13 (41.9)	8 (53.3)	0.469
SLE active score	6 (4, 8)	4 (2, 10)	6 (0,11)	0.731
CMR
LVEF/%	62.50 (54.03, 73.18)	62.95 (59.35, 70.78)	67.90 (58.00, 72.50)	0.349
LVEDV/mL	98.90 (71.23, 117.75)	111.8 (87.28, 133.28)	77.2 (58.9, 136.50)	0.824
LVEDV/BSA/(mL·m^-2)	68.54 (53.90, 80.27)	69.71 (55.20, 80.66)	48.91 (34.89, 83.48)	0.328
LVESV/mL	33.95 (23.03, 47.75)	36.10 (27.05, 49.80)	32.40 (18.90, 37.50)	0.689
LVESV/BSA/(mL·m^-2)	22.72 (15.70, 33.68)	22.83 (17.42, 29.54)	18.15 (10.93, 22.93)	0.288
LV mass/g	91.75 (74.15, 113.13)	116.40 (91.15, 130.13)	111.10 (86.50, 122.40)	0.365
LV mass/BSA/(g·m^-2)	62.91 (50.60, 75.22)	69.90 (59.67, 83.45)	57.75 (50.02, 74.86)	0.152
LV ECV/%	34.33 (31.46, 35.79)^①②	30.52 (27.84, 32.24)	31.44 (29.64, 32.61)	0.007
LV native myocardial T1/ms	1 385 (1 352, 1 427)^③	1 339 (1 303, 1 369)	1 414 (1 374, 1 466)	0.030
RVEF/%	45.80 (38.28, 59.10)	53.50 (46.60, 58.80)	47.60 (35.40, 58.10)	0.124
RVEDV/mL	117.10 (87.15, 132.80)	114.20 (100.00, 137.30)	127.30 (96.60, 178.00)	0.265
RVESV/mL	55.30 (40.75, 82.15)	55.00 (43.60, 71.10)	62.30 (42.50, 115.60)	0.145
RVEDV/BSA/(mL·m^-2)	77.24 (58.71, 97.55)	71.44 (63.28, 88.54)	67.38 (59.33, 104.40)	0.971
RVESV/BSA/(mL·m^-2)	36.02 (27.22, 59.66)	33.35 (27.46, 41.71)	33.46 (24.23, 69.85)	0.392
RV mass/g	35.70 (27.38, 55.10)	34.10 (28.30, 46.60)	44.20 (26.70, 60.40)	0.109
RV mass/BSA/(g·m^-2)	24.64 (19.43, 39.86)	22.11 (19.06, 30.09)	27.87 (15.99, 37.22)	0.128
Strain
LV-GCS/%	-20.5 (-20.8, -16.9)	-20.4 (-22.1, -17.9)	-21.7 (-22.5, -18.1)	0.479
LV-GRS/%	44.9 (32.9, 51.0)	42.5 (35.7, 48.8)	47.3 (35.0, 50.2)	0.922
LV-GLS/%	-14.9 (-19.2, -12.7)	-18.2 (-19.5, -14.9)	-17.7 (-19.4, -16.4)	0.206
RV-GCS/%	-7.3 (-8.7, -4.9)	-10.3 (-15.3, -8.5)^④⑤	-8.2 (-9.6, -3.1)	0.015
RV-GRS/%	16.0 (11.2, 18.4)	20.5 (16.0, 36.2) ^⑥⑦	13.8 (8.1, 24.1)	0.013
RV-GLS/%	-19.3 (-24.2, -15.4)	-21.1 (-25.5, -18.1)	-18.7 (-24.9, -10.6)	0.373
Laboratory examination
Hematocrit/%	33.0 (30.6, 38.8)	34.6 (31.0, 39.0)	37.0 (28.9, 40.2)	0.859
BNP/(pg·mL^-1)	368 (58, 1 463)	88 (37, 684)^⑧	358 (174, 790)	0.042
TnI/(ng·mL^-1)	0.03 (0.01, 0.18)^⑨⑩	0.01 (0.01, 0.03)	0.01 (0.01, 0.02)	0.013

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Indicator	Univariable		Multivariable
Indicator	β	P value	β	P value
BMI≤23.00 kg·m^-2
Age	-0.120	0.491	-	-
BMI	-0.457	0.006	-0.457	0.006
Disease duration	0.067	0.704	-	-
PAPm	0.151	0.461	-	-
Use of immunosuppressor	0.045	0.797	-	-
BMI>23.00 kg·m^-2
Age	0.544	0.104	-	-
BMI	0.777	0.008	0.766	0.001
Disease duration	0.061	0.867	-	-
PAPm	0.423	0.296	-	-
Use of immunosuppressor	0.550	0.100	0.534	0.004

Indicator	Univariable		Multivariable
Indicator	β	P value	β	P value
BMI≤23.00 kg·m^-2
Age	-0.120	0.491	-	-
BMI	-0.457	0.006	-0.457	0.006
Disease duration	0.067	0.704	-	-
PAPm	0.151	0.461	-	-
Use of immunosuppressor	0.045	0.797	-	-
BMI>23.00 kg·m^-2
Age	0.544	0.104	-	-
BMI	0.777	0.008	0.766	0.001
Disease duration	0.061	0.867	-	-
PAPm	0.423	0.296	-	-
Use of immunosuppressor	0.550	0.100	0.534	0.004