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类风湿关节炎中的心力衰竭和左室功能不全

Authors
Heidi M Connolly, MD, FASE
Katherine P Liao, MD, MPH
Section Editor
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Deputy Editor
Paul L Romain, MD
Translators
万伟国, 主任医师

引言

心力衰竭(heart failure, HF)是一种常见的临床综合征，可由多种结构性或功能性心脏疾病所引起。与一般人群相比，类风湿关节炎(rheumatoid arthritis, RA)患者中的HF发病率增加，而且HF可能造成RA患者的预期寿命缩短。除了症状性HF，无症状性左室收缩功能不全(定义为左室射血分数下降)在RA患者中也更常见。尽可能消除RA患者的HF风险可显著改善其生存率。

本文将总结RA患者中HF相关的问题。RA的其他心脏表现，以及HF作为抗肿瘤坏死因子(tumor necrosis factor, TNF)α靶向治疗的并发症问题，参见其他专题。 (参见“类风湿关节炎相关冠状动脉病：对预防和管理策略的影响”和“类风湿关节炎的全身表现和关节外表现概述”，关于‘心脏病变’一节和“肿瘤坏死因子-α抑制剂：不良反应概述”，关于‘心力衰竭’一节)

流行病学

人群研究 — 越来越多的人群研究估计了RA患者中HF的发病率、患病率和预后[1]。数据表明，与相似年龄和性别分布的无RA人群相比，RA患者中HF的发病率更高[2-5]。

●一项研究纳入了575例RA患者和583例无RA的患者[2,4]，在校正了年龄、性别、已知心血管危险因素和有无缺血性心脏病之后，RA患者中HF的发病率显著更高(1.99例/100人年 vs 1.16例/100人年)。

●另一项病例系列研究将603例RA患者和603例无RA的对照者相比较[3]。随访30年发现，RA患者中HF(而非缺血性心脏病)的累积发病率显著更高(37% vs 28%)。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-07.
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References
Top
  1. Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford) 2006; 45 Suppl 4:iv4.
  2. Nicola PJ, Maradit-Kremers H, Roger VL, et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum 2005; 52:412.
  3. Nicola PJ, Crowson CS, Maradit-Kremers H, et al. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. Arthritis Rheum 2006; 54:60.
  4. Crowson CS, Nicola PJ, Kremers HM, et al. How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum 2005; 52:3039.
  5. Davis JM 3rd, Maradit Kremers H, Crowson CS, et al. Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2007; 56:820.
  6. Bhatia GS, Sosin MD, Patel JV, et al. Left ventricular systolic dysfunction in rheumatoid disease: an unrecognized burden? J Am Coll Cardiol 2006; 47:1169.
  7. Seyfeli E, Guler H, Akoglu S, et al. Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. A tissue Doppler echocardiographic study. Int J Cardiovasc Imaging 2006; 22:745.
  8. Montecucco C, Gobbi G, Perlini S, et al. Impaired diastolic function in active rheumatoid arthritis. Relationship with disease duration. Clin Exp Rheumatol 1999; 17:407.
  9. Corrao S, Sallì L, Arnone S, et al. Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease. Eur J Clin Invest 1996; 26:293.
  10. Di Franco M, Paradiso M, Mammarella A, et al. Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease. Ann Rheum Dis 2000; 59:227.
  11. Gonzalez-Juanatey C, Testa A, Garcia-Castelo A, et al. Echocardiographic and Doppler findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum 2004; 33:231.
  12. Rudominer RL, Roman MJ, Devereux RB, et al. Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction. Arthritis Rheum 2009; 60:22.
  13. Giles JT, Malayeri AA, Fernandes V, et al. Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthritis Rheum 2010; 62:940.
  14. Mutru O, Laakso M, Isomäki H, Koota K. Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 1989; 76:71.
  15. Gonzalez A, Maradit Kremers H, Crowson CS, et al. Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in non-rheumatoid arthritis patients? Ann Rheum Dis 2008; 67:64.
  16. Cole J, Busti A, Kazi S. The incidence of new onset congestive heart failure and heart failure exacerbation in Veteran's Affairs patients receiving tumor necrosis factor alpha antagonists. Rheumatol Int 2007; 27:369.
  17. Whelton A, Lefkowith JL, West CR, Verburg KM. Cardiorenal effects of celecoxib as compared with the nonsteroidal anti-inflammatory drugs diclofenac and ibuprofen. Kidney Int 2006; 70:1495.
  18. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 2004; 141:764.
  19. Souverein PC, Berard A, Van Staa TP, et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart 2004; 90:859.
  20. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum 2002; 46:862.
  21. Davis JM 3rd, Roger VL, Crowson CS, et al. The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population. Arthritis Rheum 2008; 58:2603.
  22. Bernatsky S, Hudson M, Suissa S. Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis. Rheumatology (Oxford) 2005; 44:677.
  23. Wolfe F, Michaud K. Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med 2004; 116:305.
  24. Peters MJ, Welsh P, McInnes IB, et al. Tumour necrosis factor {alpha} blockade reduces circulating N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis: results from a prospective cohort study. Ann Rheum Dis 2010; 69:1281.