首页 中华风湿病学杂志 2024年28卷08期 系统性红斑狼疮心肌损伤的临床评估与治疗
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系统性红斑狼疮心肌损伤的临床评估与治疗
徐畅 
孙晓萱
王嫱
张缪佳 
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DOI： 10.3760/cma.j.cn141217-20230919-00087
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摘要
系统性红斑狼疮（SLE）是一种免疫系统紊乱的自身免疫病，可有自身抗体的异常升高，免疫复合物的大量沉积。机体长期处于慢性炎症和免疫失衡状态，可直接导致心肌损伤。SLE心肌损伤具有潜在致命性，但由于其亚临床特性，在临床上很难识别，从而使患者错过最佳治疗时机。本文阐述了SLE心肌损伤（主要是狼疮心肌炎）患者的临床特点，以及在不同辅助检查中的特征，为临床评估与诊断提供参考，以期提高患者早期诊断率，达到早期治疗降低死亡率的目的；另外，本文结合狼疮心肌损伤可能的病理机制探讨目前常见的治疗方式，并为临床提供参考。
红斑狼疮，系统性;心肌受损;心脏核磁共振
引用本文
徐畅,孙晓萱,王嫱,等. 系统性红斑狼疮心肌损伤的临床评估与治疗[J]. 中华风湿病学杂志,2024,28(08)：579-583.
DOI:10.3760/cma.j.cn141217-20230919-00087PERMISSIONS
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系统性红斑狼疮（systemic lupus erythematosus，SLE）是一种病因尚不明确，可累及全身多脏器的慢性弥漫性结缔组织病。SLE心血管损伤有多种表现，如心包炎、心肌炎、心脏瓣膜病、冠状动脉粥样硬化以及肺动脉高压等
[
1
,
2
]。其中，心肌损伤具有潜在致命性和结局可控性，早期诊疗对SLE心肌损伤患者的生活质量和预后评估十分重要
[
3
,
4
,
5
]。SLE心肌损伤常表现为狼疮心肌炎（lupus myocarditis，LM），是指狼疮疾病本身所致的心肌炎，预后不佳
[
6
,
7
,
8
]。早期发现合并心肌损伤的SLE患者并进行对症治疗，将有助于改善患者的临床结局。由于LM缺乏特异性临床表现，目前诊断LM面临巨大的挑战，因此本文对心肌损伤相关的血清学标记物，以及超声心动图、心电图、心脏核磁共振（cardiac magnetic resonance imaging，CMR）等无创辅助检查在LM临床评估中的作用进行综述，旨在提高对SLE心肌损伤患者的临床认知，采取更恰当的辅助检查和治疗方式，并降低患者死亡率。
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备注信息
A
张缪佳，Email：
mocdef.3ab61gnahz_aijoaim
B
所有作者均声明不存在利益冲突
C
国家自然科学基金面上项目 (82071827)
国家重点研发计划 (2021YFC2501305)
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