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J Rheumatol:系统性红斑狼疮患者中抗疟药诱发的心肌病

2018-10-17 xiangting MedSci原创

AMIC曾被认为极罕见,未得到充分认识,可能是由于将心衰或肥大错误地归因于其他原因。

无特殊禁忌症的所有系统性红斑狼疮(SLE)患者均被推荐使用抗疟药(AM)。抗疟药的主要不良反应是视网膜损伤;然而,在个别病例中描述有心脏病。这项研究目的是在一个明确的SLE队列中描述8名AM诱发的心肌病(AMIC)患者。

纳入参加多伦多狼疮诊所并确诊(基于心内膜心肌活检;EMB)和疑诊 [基于心脏磁共振成像(cMRI)和其他检查] AMIC的患者。

过去2年中,8名女性患者被诊断为AMIC(中位年龄62.5岁,病程35年,AM使用持续时间22年)。3名患者的诊断基于EMB(广泛的心肌细胞空泡化、胞质内髓样和曲线体)。4名患者中,cMRI高度提示AMIC(非血管模式中心室肥大和/或心房扩大及晚期钆增强)。另1名患者被诊断为完全性房室传导阻滞、左心室和室间隔肥厚并伴随眼部毒性。所有患者的心肌肌钙蛋白I(cTnI)和脑利钠肽(BNP)异常,而7/8名患者存在慢性磷酸肌酸激酶升高。在随访期间,1名患者死于顽固性心衰。在其余患者中观察到AM停药后肥大消退和心脏生物标志物稳定减少。

AMIC曾被认为极罕见,未得到充分认识,可能是由于将心衰或肥大错误地归因于其他原因。某些生物标志物(cTnI、BNP)和影像学检查结果有助于早期诊断并提高生存率。

原始出处:

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    2018-10-19 zhouqu_8
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