原发性干燥综合征对心血管风险的研究进展

Research Progress on Cardiovascular Risk in Primary Sjögren’s Syndrome

摘要: 原发性干燥综合征(primary Sjögren’s syndrome, pSS)是一种常见的系统性自身免疫病，近年来其心血管系统受累的临床意义日益受到关注。本文系统综述了pSS合并心血管疾病的流行病学、病理生理学机制、临床结局、评估监测手段及当前管理挑战。流行病学研究表明，pSS患者心血管及脑血管事件风险显著高于一般人群，尤其是心力衰竭、心肌梗死及卒中发生率升高，亚临床动脉粥样硬化(如颈动脉内中膜增厚、斑块形成)普遍存在。病理生理学机制涉及慢性炎症驱动、B细胞活化、自身抗体介导的血管损伤、I型干扰素通路激活及遗传易感性等多维度因素，其中IL-6、oxLDL抗体、Treg%等生物标志物在风险预测中展现出潜力。临床评估方面，ESSDAI疾病活动指数、器官受累评估、影像学技术(如颈动脉超声、超声心动图、心脏磁共振)及多种生物标志物共同构成多维度的风险评估体系。然而，当前领域仍面临证据基础薄弱、疾病异质性干扰、检测标准不统一、治疗与监测空白等挑战。未来需开展前瞻性多中心研究，建立标准化评估方案，整合疾病特异性因素优化风险分层，并探索靶向治疗等对心血管结局的影响，以改善pSS患者的长期预后。

Abstract: Primary Sjögren’s syndrome (pSS) is a common systemic autoimmune disease, and its clinical significance of cardiovascular system involvement has attracted increasing attention in recent years. This article systematically reviews the epidemiology, pathophysiological mechanisms, clinical outcomes, evaluation and monitoring methods, and current management challenges of pSS with cardiovascular disease. Epidemiological studies have shown that the risk of cardiovascular and cerebrovascular events in pSS patients is significantly higher than that of the general population, especially the incidence of heart failure, myocardial infarction and stroke, and subclinical atherosclerosis (such as thickening of the carotid artery intima, plaque formation) is prevalent. The pathophysiological mechanism involves multi-dimensional factors such as chronic inflammatory driver, B cell activation, autoantibody-mediated vascular injury, type I interferon pathway activation, and genetic susceptibility, among which biomarkers such as IL-6, oxLDL antibody, and Treg% have shown potential in risk prediction. In terms of clinical evaluation, ESSDAI disease activity index, organ involvement assessment, imaging techniques (such as carotid ultrasound, echocardiography, cardiac magnetic resonance) and various biomarkers together form a multi-dimensional risk assessment system. However, the current field still faces challenges such as weak evidence base, interference with disease heterogeneity, inconsistent testing standards, and gaps in treatment and monitoring. In the future, prospective multicenter studies need to be carried out, standardized assessment protocols should be established, disease-specific factors should be integrated to optimize risk stratification, and the impact of targeted therapy on cardiovascular outcomes should be explored to improve the long-term prognosis of pSS patients.