应重视系统性红斑狼疮患者心律失常

作者：Teixeira RA，et al.
翻译：兰州大学第二医院 张莉（173799427@qq.com） 审校: 沈海丽 发布者：于若寒，校正：刘佩玲
摘要：约有半数以上的系统性红斑狼疮(SLE)患者存在心脏问题。但无关于心律失常在这些患者中的患病率的研究及关于疾病发展的实验室相关预测。似乎系统性红斑狼疮典型的第二高峰死亡率与心律失常有关,主要是由于心律失常可导致猝死。自身免疫过程中,动脉粥样硬化的并发症和继发于治疗这种疾病(氯喹毒性)所出现的不良反应是这种紊乱发生的主要病理生理机制。对于自身抗体如anti-Ro / SSA和anti-RNP,的直接参与作用仍然是存在争议的。所有类型的房室传导阻滞、脑室传导障碍、病窦综合征在这种疾病都已被描述。心动过速通常需与包括窦性心动过速、心房颤动、心房异位相鉴别。长QT综合症和出现在信号平均心电图中的迟电位在系统性红斑狼疮患者中被描述，并且与其死亡率的增加有关。继发于氯喹的心脏毒性可表现为各种类型的心律失常。然而,在少数病例中发现心室束阻滞可演变为完全房室传导阻滞。由于这些不良反应很少被报道,有益的抗炎和抗免疫性能支持抗疟药物在这些疾病中的使用。对于SLE患者应进行包括传导系统在内的全面的心脏评价，以确定心律失常，防止心脏症状和心源性猝死。
附原文：Abstract Cardiac involvement is present in more than half ofthe patients with Systemic Lupus Erythematosus (SLE). However, studies on theprevalence of arrhythmias in this disease and laboratory correlationspredictive of their development do not exist. It seems possible that theclassic second mortality peak is related to arrhythmias, mainly due to thesudden nature of those deaths. Autoimmune process, atherosclerotic complications,and even adverse effects secondary to the treatment of this disorder(chloroquine cardiotoxicity) seem to be the main pathophysiological mechanismsof those disturbances. The direct participation of autoantibodies, such asanti-Ro/SSA and anti-RNP, is still controversial. All types of AV blocks (AVB),intraventricular conduction disturbances, and sick sinus syndrome have alreadybeen described in this disease. Tachycardias identified more often includesinus tachycardia, atrial fibrillation, and atrial ectopies. Long QT syndromeand the presence of late potentials in signal-averaged ECG have also beendescribed in SLE patients and they can be associated with increased mortalityrates. Cardiac toxicity secondary to chloroquine could be responsible forseveral types of arrhythmias. However, few cases of fascicular block evolvingto complete AV block have been described. Since these adverse effects arerarely reported, the beneficial anti-inflammatory and immune properties supportthe use of antimalarials in this disease. A complete cardiologic evaluationshould include the conduction system and must be carried out in all SLEpatients to identify arrhythmias, therefore preventing symptoms and also suddencardiac death.

引自：Teixeira RA, et al. Arrhythmias in systemic lupus erythematosus. RevBras Reumatol. 2010 Jan-Feb.