系统性红斑狼疮472例临床分析
摘要
系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种具有性别及年龄倾向的自身免疫性结缔组织病,机体免疫异常导致全身多器官、多系统受累为其主要特征。随着预防医学的巨大成功,很多烈性传染病得到控制,人类疾病谱发生了巨大改变,人们对自身免疫性疾病日益重视,SLE作为一种常见的典型的自身免疫性疾病日渐成为医学研究的热点之一,另外人类寿命的增长导致老人在社会人群中所占的比例越来越大,关注本人群的身体健康也显得更加重要,老人在SLE患者中占有一定比例,国内外学者将发病年龄大于50岁的SLE称之为老年性SLE (older-onset SLE)或迟发性SLE (late-onset SLE,LO SLE),老年SLE与小于50岁组SLE相比有其自身特点,在临床表现、实验室检查、治疗及预后方面均有不同,因此对SLE患者及老年SLE患者的研究有重要的临床意义。
目的
探讨系统性红斑狼疮(SLE)患者及老年性SLE患者在临床表现、实验室检查、治疗及预后等方面特点。
方法
回顾性调查郑州大学第一附属医院2008年1月-2010年1月住院的472例SLE患者,将其按年龄分为两组,≥50岁为老年SLE组,<50岁为非老年SLE组,记录每例患者临床表现、实验室检查、治疗及预后等指标,比较分析老年SLE患者临床特点。
统计学分析
统计学资料采用SPSS10.0统计软件包进行统计分析。所有数据采用均数±标准差,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,显著性界值为P<0.05。
结果
1.472例SLE患者男：女为1：8.08,平均发病年龄33.28±13.68岁(6-71.17岁)；
2.老年组患者占同期占同期SLE的10.17%,男：女(1：3.8)较非老年组男：女(1：9.10)高(P>0.05)；
3.临床表现中,老年SLE组肌痛、肌无力、浆膜炎、心脏损害、肺脏损害的发生率较非老年SLE组高(P<0.05),蝶形红斑、脱发、肾脏损害、雷诺现象、光敏感的发生率则低于非老年组；
4.老年SLE组较非老年SLE组并发带状疱疹及骨质疏松症比例增高(P<0.05)；
5.实验室检查中,老年组SLE患者白细胞降低、血小板降低比例较高(P<0.05),而抗ds-DNA抗体阳性、AnuA阳性、补体C3降低比例则低于非老年组SLE患者(P<0.05)；
6.老年SLE患者误诊率(47.92%)高于非老年组误诊率(24.53%)(P<0.05)；
7.老年SLE患者治疗,糖皮质激素用量大多偏小,其预后与非老年SLE组无明显差异(P>0.05)。
结论
1. AnuA在SLE中阳性率较高,可作为SLE诊断的一个重要指标。
2.老年SLE患者典型SLE临床表现不明显,更易误诊、漏诊。
3.老年SLE患者抗ds-DNA抗体阳性率、AnuA阳性率明显低于非老年组,故拟诊为SLE者不能因为该类抗体阴性而排除本病。
4.老年SLE患者浆膜炎、心脏、肺脏及血液系统受累比例较非老年组高,肾脏受累则较非老年组低,故对于老年SLE患者临床上应注意除肾脏外的其他内脏损害。
5. SLE治疗仍以糖皮质激素为主,老年SLE患者在使用激素治疗时剂量大多偏小。
Systemic lupus erythematosus (SLE) is a autoimmune connective tissue disease with gender and age tendency, the body's immune abnormalities associated with systemic multiple organ and many systems damage is its main features. With the enormous success of preventive medicine, many spirited contagion get control, spectrum of human disease changed dramatically, people pay more attention to autoimmune diseases, SLE as a common typical autoimmune disease has become one of the hotspot of medical research. The growth of the human lifespan brings about the proportion of old man social group is more and more big, so it appears more important to pay attention to this crowd's healthy. The old man in SLE patients, occupies some proportion, SLE patients whose onset age is older than 50 years are called Older-onset SLE or Late onset SLE(LO SLE) by domestic and overseas scholars, comparing with SLE patients whose onset age is less than 50 years, LO SLE has itself characteristics, its clinical manifestation, laboratory examination, treatment and prognosis are different, so it has very important clinical significance to study SLE and LOSLE.
Objective
To study the clinical symptoms, laboratory tests, treatment, and prognosis of systemic lupus erythematosus (SLE) and Late-onset SLE(LO SLE).
Methods
472 SLE patients who were diagnosised SLE and admitted to the first affiliated hospital of Zhengzhou university between 2008.Jan to2010.Jan were collected and a retrospective analysis of the data was done. Late-onset SLE has been defined as the disease onset occurring at age not less than 50 years.
Statistical analysis
SPSS10.0 statistical package was used to process the data using the Chi-square and T test analysis,all the data was used mean±standard deviation, P<0.05 was considered significant.
Results
1.472 SLE were investigated with a mean onset ages 33.28±13.68years (6-71.17years) and Gender ratio was found to be 1:8.08.
2. The incidence of SLE in the elderly was 10.17%,the sex ratio (M/F= 1:3.8) is higher than that of the yonger group((M/F=1:9.10),but it was not statistically significant (P>0.05)
3. Compared with the yonger group, prevalence of Muscle pain, muscle weakness, serositis, heart damage and lung damage were observed more often in Late onset SLE patients(P<0.05); Malar rash, alopecia, renal damage, Raynaud's phenomenon, and photosensitivity occur rarely in the elderly patients with late SLE onset(P<0.05)
4. The concurrent incidence of osteoporosis and herpes zoster in Late onset SLEgroup is higher than that in the yonger group(P<0.05).
5. Late onset SLE patients manifested lower rate of positive findings of anti-dsDNA antibidies and anti-nucleosome antibodies, the lower occurrence of reduction of Complement C3,and the higher occurence of thrombocytopenia and leukopenia.
6. The Misdiagnosis rate of Late-onset SLE (47.92%) is higher than that of the yonger patients (24.53%) (P<0.05)
7. Treatment of the disease, Late onset SLE patients should use slants lower doses of glucocorticoids. And there is no statistical diference in the prognosis ofthe two groups (P>0.05)
Conclusion
1. The positive rate of AnuA in SLE is so high that it can be used as a important index of SLE diagnosis.
2. There is less typical clinical manifestations of SLE in Late-onset SLE, resulting in misdiagnosis more easily.
3. Because of the positive rate of anti-dsDNA antibidies and anti- nucleosome antibodies is found lower in Late onset SLE patients, we can not eliminate the disease for patients whose those antibodies are negative.
4. Comparing with the yonger SLE patients,the incidence of serositis, heart damage, pulmonary damage and hematological involvement in Late onset SLE patients were higher, and renal involvement were lower,so we should pay attention to visceral damage except kidney damage of Late onset SLE patients.
5. Glucocorticoids are still the most important and foundational drugs to treatment of SLE, and the doses of glucocorticoids most always be slants low in Late onset SLE patients.
目的
探讨系统性红斑狼疮(SLE)患者及老年性SLE患者在临床表现、实验室检查、治疗及预后等方面特点。
方法
回顾性调查郑州大学第一附属医院2008年1月-2010年1月住院的472例SLE患者,将其按年龄分为两组,≥50岁为老年SLE组,<50岁为非老年SLE组,记录每例患者临床表现、实验室检查、治疗及预后等指标,比较分析老年SLE患者临床特点。
统计学分析
统计学资料采用SPSS10.0统计软件包进行统计分析。所有数据采用均数±标准差,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,显著性界值为P<0.05。
结果
1.472例SLE患者男：女为1：8.08,平均发病年龄33.28±13.68岁(6-71.17岁)；
2.老年组患者占同期占同期SLE的10.17%,男：女(1：3.8)较非老年组男：女(1：9.10)高(P>0.05)；
3.临床表现中,老年SLE组肌痛、肌无力、浆膜炎、心脏损害、肺脏损害的发生率较非老年SLE组高(P<0.05),蝶形红斑、脱发、肾脏损害、雷诺现象、光敏感的发生率则低于非老年组；
4.老年SLE组较非老年SLE组并发带状疱疹及骨质疏松症比例增高(P<0.05)；
5.实验室检查中,老年组SLE患者白细胞降低、血小板降低比例较高(P<0.05),而抗ds-DNA抗体阳性、AnuA阳性、补体C3降低比例则低于非老年组SLE患者(P<0.05)；
6.老年SLE患者误诊率(47.92%)高于非老年组误诊率(24.53%)(P<0.05)；
7.老年SLE患者治疗,糖皮质激素用量大多偏小,其预后与非老年SLE组无明显差异(P>0.05)。
结论
1. AnuA在SLE中阳性率较高,可作为SLE诊断的一个重要指标。
2.老年SLE患者典型SLE临床表现不明显,更易误诊、漏诊。
3.老年SLE患者抗ds-DNA抗体阳性率、AnuA阳性率明显低于非老年组,故拟诊为SLE者不能因为该类抗体阴性而排除本病。
4.老年SLE患者浆膜炎、心脏、肺脏及血液系统受累比例较非老年组高,肾脏受累则较非老年组低,故对于老年SLE患者临床上应注意除肾脏外的其他内脏损害。
5. SLE治疗仍以糖皮质激素为主,老年SLE患者在使用激素治疗时剂量大多偏小。
Systemic lupus erythematosus (SLE) is a autoimmune connective tissue disease with gender and age tendency, the body's immune abnormalities associated with systemic multiple organ and many systems damage is its main features. With the enormous success of preventive medicine, many spirited contagion get control, spectrum of human disease changed dramatically, people pay more attention to autoimmune diseases, SLE as a common typical autoimmune disease has become one of the hotspot of medical research. The growth of the human lifespan brings about the proportion of old man social group is more and more big, so it appears more important to pay attention to this crowd's healthy. The old man in SLE patients, occupies some proportion, SLE patients whose onset age is older than 50 years are called Older-onset SLE or Late onset SLE(LO SLE) by domestic and overseas scholars, comparing with SLE patients whose onset age is less than 50 years, LO SLE has itself characteristics, its clinical manifestation, laboratory examination, treatment and prognosis are different, so it has very important clinical significance to study SLE and LOSLE.
Objective
To study the clinical symptoms, laboratory tests, treatment, and prognosis of systemic lupus erythematosus (SLE) and Late-onset SLE(LO SLE).
Methods
472 SLE patients who were diagnosised SLE and admitted to the first affiliated hospital of Zhengzhou university between 2008.Jan to2010.Jan were collected and a retrospective analysis of the data was done. Late-onset SLE has been defined as the disease onset occurring at age not less than 50 years.
Statistical analysis
SPSS10.0 statistical package was used to process the data using the Chi-square and T test analysis,all the data was used mean±standard deviation, P<0.05 was considered significant.
Results
1.472 SLE were investigated with a mean onset ages 33.28±13.68years (6-71.17years) and Gender ratio was found to be 1:8.08.
2. The incidence of SLE in the elderly was 10.17%,the sex ratio (M/F= 1:3.8) is higher than that of the yonger group((M/F=1:9.10),but it was not statistically significant (P>0.05)
3. Compared with the yonger group, prevalence of Muscle pain, muscle weakness, serositis, heart damage and lung damage were observed more often in Late onset SLE patients(P<0.05); Malar rash, alopecia, renal damage, Raynaud's phenomenon, and photosensitivity occur rarely in the elderly patients with late SLE onset(P<0.05)
4. The concurrent incidence of osteoporosis and herpes zoster in Late onset SLEgroup is higher than that in the yonger group(P<0.05).
5. Late onset SLE patients manifested lower rate of positive findings of anti-dsDNA antibidies and anti-nucleosome antibodies, the lower occurrence of reduction of Complement C3,and the higher occurence of thrombocytopenia and leukopenia.
6. The Misdiagnosis rate of Late-onset SLE (47.92%) is higher than that of the yonger patients (24.53%) (P<0.05)
7. Treatment of the disease, Late onset SLE patients should use slants lower doses of glucocorticoids. And there is no statistical diference in the prognosis ofthe two groups (P>0.05)
Conclusion
1. The positive rate of AnuA in SLE is so high that it can be used as a important index of SLE diagnosis.
2. There is less typical clinical manifestations of SLE in Late-onset SLE, resulting in misdiagnosis more easily.
3. Because of the positive rate of anti-dsDNA antibidies and anti- nucleosome antibodies is found lower in Late onset SLE patients, we can not eliminate the disease for patients whose those antibodies are negative.
4. Comparing with the yonger SLE patients,the incidence of serositis, heart damage, pulmonary damage and hematological involvement in Late onset SLE patients were higher, and renal involvement were lower,so we should pay attention to visceral damage except kidney damage of Late onset SLE patients.
5. Glucocorticoids are still the most important and foundational drugs to treatment of SLE, and the doses of glucocorticoids most always be slants low in Late onset SLE patients.
引文
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