系统性红斑狼疮十年随访

报道５０例ＳＬＥ患者的１０年（１９８０年￣１９９０年）随访结果。１０年的生存率情况，以发病时间计算，其一年、五年、十年生存率分别为９８％、９８％、８４％，以确诊时间计算，则分别为９８％、８６％、７６％。本组患者十年死亡１２例（２４％），感染与明功能衰竭为两大主要死因，分别占３３％及３３％。７４％存活的患者能很好工作与生活，１２例患者病人情缓解，平均缓解时间４年（２年￣９年）随访，结果表明ＳＬＥ的早     

系统性红斑狼疮十年随访

报道50例SLE患者的10年(1980年～1990年)随访结果。10年的生存率情况,以发病时间计算,其一年、五年、十年生存率分别为98％、98％、84％,以确诊时间计算,则分别为98％、86％、76％。本组患者十年中死亡12例(24％),感染与肾功能衰竭为两大主要死因,分别占33％及33％。74％存活的患者能很好工作与生活,12例患者病情缓解,平均缓解时间4年(2年～9年)随访,结果表明SLE的早期诊断,以及预防感染与肾衰是进一步降低SLE死亡率的两大关键。     

系统性红斑狼疮五年生存率及预后因素分析

目的 回顾性分析系统性红斑狼疮(SLE)患者5年生存率、死亡原因及影响预后的因素. 方法 收集我院1998-2005年住院初发的243例SLE患者的临床及血清学资料,并进行随访.用非参数乘积法分析生存率,比例风险模型(Cox参数回归)分析预后因素. 结果 从诊断时计算SLE患者1、3、5年生存率分别为96%、94%和91%.肾功能衰竭和感染是最常见的死亡原因,其次是神经精神狼疮和肺动脉高压.多因素分析显示诊断时狼疮肾损害和神经精神狼疮是死亡的独立危险因素,而诊断时年龄、性别、血液系统异常、低补体、抗dsDNA抗体阳性、肺损害、心脏损害以及联合免疫抑制剂治疗对存活影响无统计学意义. 结论 早期诊断及控制SLE脏器损害,同时预防感染,是提高患者生存率的关键.     

系统性红斑狼疮相关肺动脉高压

系统性红斑狼疮(SLE) 是一种以多器官系统受累为主要特征的自身免疫性疾病,肺动脉高压(PAH) 是其常见 和严重并发症。中国导致PAH 最常见的结缔组织病是SLE,自身免疫反应及炎症是其发生和进展的主要因素。临 床表现包括SLE 本身和PAH 两个方面。SLE 相关PAH 患者的预后较其他结缔组织病相关PAH 患者更好,因为针 对原发病SLE 的免疫抑制治疗有效。针对PAH 的靶向药物对于SLE 相关PAH 的治疗有效,尤其用于免疫制剂治 疗无效的患者。早期发现和恰当治疗是改善患者预后的关键。     

系统性红斑狼疮相关肺动脉高压的诊治

系统性红斑狼疮(systemic lupus erythematous,SLE)是一种以多器官系统受累和多种自身抗体阳性为主要特征的系统性自身免疫性疾病。肺动脉高压(pulmonary arterial hypertension,PAH)是指静息状态下,右心导管检查发现平均肺动脉压(mPAP)≥3.3 kPa,肺血管阻力(PVR)≥3个Wood单位[1个Wood单位=8 kPa/(L·s)],且毛细血管楔压≤2 kPa     

系统性红斑狼疮不良妊娠结局相关因素

目的 探讨系统性红斑狼疮(systemic lupus erythematosus, SLE)患者不良妊娠结局的相关因素。方法 对83例SLE患者85次妊娠事件的临床资料进行回顾性分析,采用Logistic回归模型分析不良妊娠结局的相关因素。结果 病情活动的SLE患者发生妊娠丢失(60%)、早产(30%)、子痫前期(43%)的风险更高(P<0.05)。SLE患者胎儿不良妊娠(adverse pregnancy outcomes, APO)和妊娠丢失组出现孕中发病、病情活动、白细胞下降、低补体、抗dsDNA阳性及泼尼松用量≥20 mg/d的比例升高。且接受临床干预的具有不良妊娠史(OR=5.837,95%CI:1.799～18.911,P=0.003)的SLE患者再次妊娠时,出现胎儿AP0的风险降低,其中皮疹(OR=0.047,95%CI:0.005～0.453,P=0.008)、抗SSA阳性(OR=0.265,95%CI:0.084～0.838,P=0.024)、泼尼松用量≥20 mg/d(OR=0.062,95%CI:0.010～0.391,P=0.003)是SLE胎儿APO相...     

系统性红斑狼疮相关骨质疏松

随着对系统性红斑狼疮诊治认识的发展,骨质疏松作为其长期并发症之一得到更多的关注与研究。系统性红 斑狼疮合并骨质疏松的原因包括疾病本身的病程及损害,慢性多器官功能异常,治疗药物因素等多方面,其中除传 统研究中证明的因素外,系统活动性炎症,体内激素水平、月经周期,神经精神因素等也参与其发生,最终表现为骨 量流失增加,骨组织的细微结构破坏导致承重力下降,甚至骨折,治疗中应予以重视。     

系统性红斑狼疮50例10年预后及其影响因素分析

目的研究系统性红斑狼疮(SLE)患者的预后和影响预后的危险因素。方法对1980—1990年就诊于上海第二医科大学仁济医院风湿病科50例SLE患者的临床资料进行回顾性分析。结果以确诊时间计算,其1年、5年、10年存活率分别为98%、86%、76%。12例缓解,其平均缓解时间为4年。38例存活,28例正常工作和生活;发病时未婚女青年24例,发病后21例已婚,16例正常生育。12例死亡,主要死亡原因为肾功能衰竭(33.3%)和感染(33.3%)。影响预后的因素多脏器受累,弥漫性血管炎,持续性低补体血症,严重贫血,血肌酐升高,重度蛋白尿。血小板减少对预后无不良影响。未发现中枢性狼疮对预后的严重影响。伴发雷诺现象(RP)14例,其中5例死亡,9例存活中6例RP消失,表明RP可以逐渐消失,对预后无不良影响。结论早期诊断和治疗,防治激素治疗的副反应,控制感染和肾功能衰竭有助于改善SLE患者的预后,提高存活率。     

小儿系统性红斑狼疮危险因素分析

系统性红斑狼疮(ｓｙｓｔｅｍｉｃｌｕｐｕｓｅｒｙｔｈｅｍａｔｏｓｕｓ,ＳＬＥ)是一种全身性自身免疫性疾病,多见于生育期妇女,儿童并不少见。小儿起病急,如果不得到及时、系统的治疗,5～10年病死率达20%,接近成人[1]。本文立足临床,结合病史、实验室检查及治疗情况对我院近15年收治的113例ＳＬＥ患儿进行临床分析,试图找出与ＳＬＥ死亡有关的因素,探讨治疗小儿ＳＬＥ的更为合理的措施。1　资料与方法11　研究对象以1983年3月至1998年3月在我院儿科病房住院的113例ＳＬＥ患儿为研究对象。全部病例符合美国风湿病学会(ＡＲＡ)1982年修订的…     

系统性红斑狼疮患者动脉僵硬度及其相关危险因素的研究

目的 评价系统性红斑狼疮(SLE)患者动脉僵硬度,并探讨其相关危险因素.方法 本研究为横断面研究,共纳入中国系统性红斑狼疮研究协作组(CSTAR)的SLE患者135例.利用动脉僵硬度检测仪测定患者臂踝脉搏波传导速度(baPWV),同时采集心血管相关的传统危险因素以及SLE相关因素.利用SAS软件进行统计分析.结果 (1)动脉僵硬度增高的SLE患者其年龄、心血管疾病家族史、平均动脉压和糖化血红蛋白与动脉僵硬度正常的SLE患者比较差异有统计学意义(P均＜0.05).动脉僵硬度增高的SLE患者其肌酐清除率低于动脉僵硬度正常的SLE患者,病程和羟氯喹使用疗程长于动脉僵硬度正常的SLE患者(P均＜0.05),静脉使用环磷酰胺的比例高于动脉僵硬度正常的SLE患者[OR =3.04,95％ CI:1.230 ～7.514,P=0.013].(2)对上述混淆因素进行调整后,年龄[OR=4.56,95％ CI:1.863 ～ 11.130,P=0.000]、平均动脉压[OR=1.12,95％CI:1.055～1.196,P=0.000]、SLE病程[OR=1.20,95％ CI:1.050 ～1.367,P =0.007]以及静脉使用环磷酰胺比例[OR=2.86,95％ CI:1.364 ～5.979,P=0.005]是SLE患者动脉僵硬度增高的独立危险因素.结论 传统心血管危险因素及SLE特异性相关因素均与SLE患者动脉僵硬度增高相关.     

Predictors of survival in systemic lupus erythematosus

ABSTRACT: We conducted the current study to determine the impact of demographic factors, household income, clinical manifestations, disease activity, serologic tests, and calendar year on survival among patients with systemic lupus erythematosus (SLE). In a large prospective cohort of patients with SLE, we used the Kaplan-Meier method to estimate survival probabilities of SLE patients over time since diagnosis. We analyzed the predictors of survival in SLE using Cox proportional hazards models.The study included 1378 patients with SLE, with a median follow-up in the cohort of 6.1 years. One hundred eighteen patients died (8.6%). The overall cumulative probability of survival after disease diagnosis at 5, 10, 15, and 20 years was 95%, 91%, 85%, and 78%, respectively. Based on a multivariable model, age at SLE diagnosis >or=50 years old (hazard ratio [HR]=5.9; p<.001) and male gender (HR=2.4; p=.004) were associated with poorer survival. Patients with annual family income<25,000 dollars had poorer survival (HR=1.7; p=.040). The presence of hemolytic anemia in the first year after disease diagnosis (p=.016) or during the follow-up period (p=.031) increased the risk of death. A low complement level during the first year after diagnosis was the only serologic marker of poorer survival (p=.013 for low C3 level and p=.053 for low C4 level).     

Prognostic factors in systemic lupus erythematosus

Summary In the past 40 years an impressive improvement in the prognosis of SLE patients has occurred. Factors which might be responsible for this improvement are discussed. Two of the factors most frequently cited are the advances in disease recognition and treatment. However, as already noted by Albert (1979) this is questionable, as average disease duration and survival have increased in a linear fashion related to the number of publications devoted to this subject from 1950 on. Further evaluation of the literature shows that the most prominent factors which have an impact on the survival rate are specific disease manifestations (lupus nephritis) and the overall disease course (number of exacerbations). This effect of morbidity on the survival rate is greater than that of factors such as sex and race. Socio-economic factors or age at onset have no effect on the outcome.     

Atherosclerosis risk factors in systemic lupus erythematosus

Cardiovascular disease (CVD) has emerged as a leading cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Growing evidence suggests that inflammation plays a key role in the pathogenesis of atherosclerosis from initial endothelial dysfunction to rupture of atheromatous plaques. The increased frequency of atherosclerosis in SLE is likely due to a complex interplay among traditional risk factors, disease-related factors such as medications and disease activity, and inflammatory and immunogenic factors. Identification of these novel risk factors will lead to a better understanding of CVD pathogenesis and may also provide targets for potential treatment strategies. When caring for SLE patients, clinicians should be aware of the increased CVD risk and treat the known modifiable risk factors in addition to controlling disease activity and inflammation.     

The actual survival rate in systemic lupus erythematosus: Study of a 1976 cohort

Summary The purpose of this study was to establish the actual survival rate of a cohort of 51 patients with systemic lupus erythematosus (SLE) all of whom were followed during 12 years from 1976 to 1988 and to evaluate the prognostic significance of the severe complications of the disease. Forty-eight were females. The mean age was 28.5 at onset, 36.2 at diagnosis and 42 at entry; 80% had four or more 1982 ARA criteria at diagnosis and 96% in 1988. Survival rates were: 96% at two years, 86.3% at five years and 74.5% at twelve years. The main cause of death was infection (62%); SLE was directly responsible in only one case. Manifestations considered as severe occurred in almost two-thirds of the cases without any concordance in the time sufficient to recognize different severe forms of the disease.