上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 2: 180 - 186

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.02.009

论著·临床研究

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
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  • 上海交通大学医学院附属仁济医院心内科，上海 200127
冯泽豪（1994—），男，硕士生；电子信箱：fengzehao2016@126.com。

收稿日期: 2020-05-06

  网络出版日期: 2021-02-28

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)

收起

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

Received date: 2020-05-06

  Online published: 2021-02-28

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)

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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

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2021.02.009

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)

参考文献

1 Abdel-Aty H, Siegle N, Natusch A, et al. Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach[J]. Lupus, 2008, 17(6): 561-567.
2 Guo Q, Wu LM, Wang Z, et al. Early detection of silent myocardial impairment in drug-naive patients with new-onset systemic lupus erythematosus: a three-center prospective study[J]. Arthritis Rheumatol, 2018, 70(12): 2014-2024.
3 Thomas G, Mancini J, Jourde-Chiche N, et al. Mortality associated with systemic lupus erythematosus in France assessed by multiple-cause-of-death analysis[J]. Arthritis Rheumatol, 2014, 66(9): 2503-2511.
4 Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss[J]. J Am Coll Cardiol, 2009, 53(21): 1925-1932.
5 Hall ME. Body mass index and heart failure mortality: more is less?[J]. JACC Heart Fail, 2018, 6(3): 243-245.
6 Eikendal ALM, den Ruijter HM, Haaring C, et al. Sex, body mass index, and blood pressure are related to aortic characteristics in healthy, young adults using magnetic resonance vessel wall imaging: the AMBITYON study[J]. MAGMA, 2018, 31(1): 173-182.
7 McQuade JL, Daniel CR, Hess KR, et al. Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis[J]. Lancet Oncol, 2018, 19(3): 310-322.
8 罗玲, 尹立雪. 系统性红斑狼疮心血管系统病变的超声研究进展[J]. 中国医学影像学杂志, 2018, 26(4): 312-316, 320.
9 Katz P, Gregorich S, Yazdany J, et al. Obesity and its measurement in a community-based sample of women with systemic lupus erythematosus[J]. Arthritis Care Res (Hoboken), 2011, 63(2): 261-268.
10 Giannelou M, Mavragani CP. Cardiovascular disease in systemic lupus erythematosus: a comprehensive update[J]. J Autoimmun, 2017, 82: 1-12.
11 Bruce IN, Urowitz MB, Gladman DD, et al. Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study[J]. Arthritis Rheum, 2003, 48(11): 3159-3167.
12 Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus[J]. Arthritis Rheum, 2012, 64(8): 2677-2686.
13 Gallagher D, Heymsfield SB, Heo M, et al. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index[J]. Am J Clin Nutr, 2000, 72(3): 694-701.
14 Gladman DD, Iba?ez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000[J]. J Rheumatol, 2002, 29(2): 288-291.
15 Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography[J]. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
16 Lavie CJ, Alpert MA, Arena R, et al. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure[J]. JACC Heart Fail, 2013, 1(2): 93-102.
17 Powell-Wiley TM, Ngwa J, Kebede S, et al. Impact of body mass index on heart failure by race/ethnicity from the get with the guidelines-heart failure (GWTG-HF) registry[J]. JACC Heart Fail, 2018, 6(3): 233-242.
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