26例系统性红斑狼疮患者死亡原因分析

系统性红斑狼疮(SLE)是自身免疫性疾病中最具代表性的一种,免疫异常累及全身各器官、各系统,临床表现复杂,病程迁延反复,死亡率较高,死亡原因多样.现对我科26例SLE死亡患者的死亡原因、内脏受累情况、激素应用剂量等进行回顾性分析. 临床资料 1.对象:2000年4月～2011年4月在上海市中医医院风湿科诊治的SLE患者398例,所有患者均符合《美国风湿病协会1997年制定的SLE分类标准》4项或4项以上[1].死亡患者26例,均为女性,年龄23～75岁,平均年龄42.3岁,SLE病程为2个月～29年,平均病程11.7年.     

300例系统性红斑狼疮患者20年随访的预后分析

研究300例系统性红斑狼疮(SLE)患者的死亡率和死亡原因。回顾性分析了1978年1月～2000年7月的300例诊所SLE患者,均符合1982年美国风湿病学院的诊断标准,其中除外药物性狼疮和盘状狼疮病例。病者在确诊SLE后5年内死亡者定为早期死亡,确诊SLE后5年以后死亡者定为晚期死亡。每例均分析其死因,井算出各年龄组SLE患者的标准化死亡比率。 结果SLE患者中的死亡者与存活者相比,可见确诊年龄较高(36.8对28.5岁),SLE患者的平均病程为13年,平均随访时间为8.3     

系统性红斑狼疮死亡患者感染部位和病原菌分析

目的 了解近年来系统性红斑狼疮(SLE)感染死亡患者的感染部位和感染病原菌.方法 回顾分析1986年1月至2011年5月北京协和医院SLE住院死亡病例资料.结果 1986年1月至2011年5月SLE住院死亡患者共252例,其中感染为主要死因的患者共97例,非感染原因为主要死因的患者共155例,感染在同期死亡患者中的比例逐渐上升.1986-1990年、1991-1995年、1996-2000年、2001-2005年和2006-2011年,感染死亡患者占同期死亡患者的比例分别为25.7％,24.1％,31.6％,34.9％和60.3％.在因感染死亡的患者中,肺部感染是主要的感染部位,共63例,占感染死亡患者的65％;回顾2006年1月至2011年5年SLE患者肺部感染患者,其中31例患者的病原菌明确,其中单一病原菌感染共14例,占45％,混合感染共17例,占55％.在单一病原菌感染死亡的患者中,最常见的病原菌是真菌感染,共9例,其中耶氏肺孢子菌肺炎4例,烟曲霉感染2例,镰刀菌属1例,热带念珠菌1例,隐球菌1例;普通细菌感染3例,其中耐甲氧西林金黄色葡萄球菌2例,肺炎克雷伯杆菌1例;死于肺结核2例.在混合感染死亡的患者中,混合细菌感染最常见,共14例,其中常见的混合细菌感染依次为鲍曼不动杆菌、大肠埃希菌、肠球菌、肺炎克雷伯杆菌、绿脓杆菌和阴沟肠杆菌,分别为6例、3例、2例、2例、2例和1例;混合真菌感染的患者共11例,在混合真菌感染的患者中烟曲霉菌6例,热带念珠菌3例,耶氏肺孢子菌3例,黄曲霉2例,土曲霉1例,白色念珠菌2例,光滑念珠菌1例,克柔念珠菌1例;除普通细菌和真菌以外,巨细胞病毒感染也是混合感染中常见的病原菌,共5例.结论 感染已成为SLE的最主要死因;肺部感染是最常见的感染部位,混合感染常见,烟曲霉菌、耶氏肺孢子菌、鲍曼不动杆菌和巨细胞病毒感染是以感染为主要死因患者的常见病原体.     

系统性红斑狼疮患者医院感染分析

系统性红斑狼疮(SLE)是一种自身免疫性疾病，自从使用肾上腺糖皮质激素及免疫抑制剂治疗以来，患者长期预后得到改善，但感染发生率却明显增加。为了解我院SLE患者院内感染情况，对我院187例次SLE患者进行回顾性分析。     

近25年系统性红斑狼疮的死因构成回顾性研究

目的 了解近25年系统性红斑狼疮(SLE)患者主要死因构成的变化.方法 回顾分析1986年1月至2011年5月北京协和医院SLE住院患者的死亡病例.采用x2检验、t检验和Kaplan-Meier 方法进行分析.结果 近25年SLE的住院患者共3554例,死亡252例,女性223例,男性29例,SLE死亡患者占同期SLE住院患者的7.1％;其中女性为7.2％,男性为6.2％,两者差异无统计学意义(P=0.404);感染、狼疮脑病和狼疮肾炎为SLE 3个最常见的主要死因,分别占总死亡人数的38.5％、17.1％和12.3％,弥漫性肺泡出血、肺动脉高压、冠心病、血小板减少继发出血、肺间质病变、狼疮肺炎、消化道出血、肠梗阻和多脏器功能衰竭也是SLE的常见死因,占总死亡人数的4.4％、4.4％、3.2％、2.8％、2.4％、2.0％、2.0％、1.2％和1.2％.1986年1月至1990年12月主要死因为狼疮肾炎、感染和狼疮脑病的患者分别占同期死亡患者的31.4％、25.7％和25.7％;1991年1月至1995年12月主要死因为狼疮肾炎、感染和狼疮脑病的患者分别占同期死亡患者的27.6％、24.1％和24.1％;1996年1月至2000年12月主要死因为感染、狼疮脑病和狼疮肾炎的患者分别占同期死亡患者的31.6％、21.1％和15.8％;2001年1月至2005年12月主要死因为感染、狼疮脑病和狼疮肾炎的患者分别占同期死亡患者的34.9％、20.6％和7.9％;2006年1月至2011年5月感染是最常见的死因,其次为狼疮脑病和肺动脉高压,分别占同期死亡患者的60.3％、11.8％和7.4％,主要死因为狼疮肾炎的患者仅1例,占同期死亡患者的1.5％.SLE患者在发病1年内死亡最常见,占总死亡人数的32.5％;其中狼疮脑病和感染死亡在发病1年内最常见,分别占狼疮脑病和感染死亡人数的41.9％和32.9％;狼疮肾炎死亡在发病10年后最常见,占狼疮肾炎死亡总人数的32.3％.性别和发病年龄与SLE主要死因有关,冠心病男性死亡患者占50.0％,因冠心病死亡的患者发病年龄50岁以上者占75.0％.结论 1986-2005年,感染、狼疮脑病和狼疮肾炎是SLE的3个最常见死因,2006年至今,肺动脉高压取代狼疮肾炎成为SLE第三大死因.SLE死亡患者死于发病1年内比例最高.SLE患者感染死亡逐渐增多,已成为SLE的最常见死因.     

重症监护病房系统性红斑狼疮患者预后因素分析

目的 了解重症监护病房(ICU)危重症系统性红斑狼疮(SLE)患者的预后及其影响因素.方法 1993年6月至2007年6月所有第1次入住ICU的SLE患者纳入组,除外入住ICU后确诊为SLE患者.对在单蹦素相关分析中提示对SLE患者死亡有明显相关性的临床指标进一步采用多因素回归模型分析.结果 符合SLE分类标准的患者共101例,总体病死率为48.6%.入住ICU最常见原因是肺部病变并发急性呼吸窘迫综合征(ARDS).多因素回归分析提示SLE疾病慢性损伤指数(SLICC/ACR DI)>7.7、急性生理和慢性健康评估指数(APACHE Ⅲ)≥21、肺部病变并发ARDS、败血症休克、颅内出血、血细胞减少、近1个月平均等效泼尼松剂量>25 mg/d和气管插管时间>4 d与ICU危重症SLE患者死亡明显相关.而性别、年龄、SLE疾病活动指数(SLEDAI)>27、上消化道出血、甲泼尼龙冲击和末月使用环磷酰胺>1.0 g与死亡结果无明显相关性.结论 人住ICU危重症SLE患者病死率很高,死亡第1位原因是感染.与其死亡明显相关的因素主要有SLICC/ACR DI>7.7、APACHE Ⅲ>121、肺部病变并发ARDS、败血症休克、颅内出血、血细胞减少、近1个月平均等效泼尼松剂量>25 mg/a和气管插管时间>4 d.     

系统性红斑狼疮患者细胞免疫功能的研究

系统性红斑狼疮患者细胞免疫功能的研究山东医科大学附属医院（２５００１２）宋强，宋素芹，李杰，张明珙山东省千佛山医院张丽丽，李凯为探讨细胞免疫功能在ＳＬＥ发病中的作用，我们测定了３０例ＳＬＥ患者的Ｔ细胞亚群及ＨＬＡ－ＤＲ抗原的表达，现报告如下。１资料及...     

系统性红斑狼疮患者程序性死亡配体-1表达的初步研究

目的检测系统性红斑狼疮(SLE)患者外周血单个核细胞(PBMC)程序性死亡配体-1(PD-L1)的表达水平,探讨其在系统性红斑狼疮发病过程中的作用。方法密度梯度离心法分离系统性红斑狼疮患者和正常人PBMC,采用半定量RT-PCR检测PBMC的PD-L1mRNA表达。结果系统性红斑狼疮患者活动期组和稳定期组的PD-L1mRNA表达与对照组比较明显增高,差异有显著性(P均<0.05);但PD-L1mRNA表达在系统性红斑狼疮活动期组与稳定期组之间比较无显著性差异(P>0.05)。结论系统性红斑狼疮患者外周血单个核细胞PD-L1mRNA表达水平增加,程序性死亡配体-1可能在系统性红斑狼疮的发病机制中有一定的作用。     

系统性红斑狼疮发病机理的新观点

系统性红斑狼疮发病机理的新观点宦红娣唐政关键词系统性红斑狼疮程序化死亡发病机理中图法分类号Ｒ５９３．２４１南京军区南京总医院解放军肾脏病研究所（南京，２１００２１）系统性红斑狼疮（ｓｙｓｔｅｍｉｃｌｕｐｕｓｅｒｙ－ｔｈｅｍａｔｏｓｕｓ，ＳＬＥ，简称狼...     

Mortality and causes of death in systemic lupus erythematosus

Cohort studies of survival in systemic lupus erythematosus (SLE) often have been limited by methodologic problems. In studies of inception cohorts of patients followed since 1980, survival at 5 years has exceeded 90%. These estimates are generally higher than survival estimates from earlier studies, suggesting that short-term survival in SLE has improved. There is less evidence to support major improvements over time in survival after 10 years or more of SLE. Infections, atherosclerotic disease, and active systemic lupus erythematosus or organ damage caused by SLE are the main causes of death in patients with SLE, but the proportion of early deaths caused by active SLE has decreased over time.     

Mortality and causes of death of 513 Danish patients with systemic lupus erythematosus

A multicentre cohort of 513 clinic attenders with systemic lupus erythematosus (SLE) was retrospectively identified, representing 4185 patient-years of follow-up. Expected numbers of death were calculated by means of age- and sex-specific mortality rates of the general Danish population. The observed number of deaths was 122. The survival rates were 97%, 91%, 76%, 64% and 53% after 1, 5, 10, 15, and 20 years respectively. The overall mortality rate was 2.9% per year (95% CI 2.4-3.5), and the standardized mortality rate (SMR) was 4.6 (95% CI 3.8-5.5). The causes of death included active SLE (n = 19), end stage organ failure due to SLE (n = 16), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32), and other causes (n = 21). SLE was directly related to one third of the excess mortality. In conclusion, SLE patients in the present cohort had a 4.6-fold increased mortality compared with the general population and half of the deaths were caused by SLE manifestations or infections, especially in young patients during the early period of the disease.     

Long-term prognosis and causes of death in systemic lupus erythematosus

Purpose

We studied survival rate, prognostic factors, and causes of death in patients with systemic lupus erythematosus (SLE), particularly focusing on the influence of disease severity.

Patients and Methods

A cohort of 207 consecutive Italian patients with SLE were prospectively studied. All prominent clinical and serologic parameters were evaluated and considered as prognostic risk factors. Causes of death were defined on the basis of clinical data and, when available, postmortem examination. Survival was calculated from the time of diagnosis by Kaplan-Meier method.

Results

A total of 17 of 207 patients died; causes of death were active disease manifestations in 35.3% of cases and complication of the disease or its treatment in 64.7% of cases. The survival rates at 5, 10, and 15 years after the diagnosis were 96%, 93% and 76%, respectively. By multivariate analysis of the risk factors, a predictive model consisting of male gender, positive lupus anticoagulant, and “severe” SLE was identified. The survival curve of the patients with severe disease was similar to that of patients with mild disease until 10 to 15 years from the diagnosis. Thereafter the two curves tended to diverge, showing a clear survival decline in patients with severe disease.

Conclusions

Our study confirms the increase of short- and medium-term survival in patients with SLE, but long-term prognosis remains poor in patients with severe SLE manifestations.     

Mortality in systemic lupus erythematosus

OBJECTIVE: To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled. METHODS: Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined. RESULTS: The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001. CONCLUSION: Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.     

The causes of death in Korean patients with systemic lupus erythematosus over 11 years

We investigated the causes of death and analyzed the prognostic factors in Korean systemic lupus erythematosus (SLE) patients. We evaluated 1010 patients with SLE who visited Seoul Saint Mary's Hospital from 1997-2007. Changing patterns in the causes of death were analyzed. Survival rate was calculated by the Kaplan-Meier method and the log-rank test. The risk factors for death were analyzed by multivariate logistic regression analysis. The 5-year survival rate was 97.8%. Over the period of the study, 59 deaths were observed. Among 44 patients who died in our hospital, the most common cause of death was infection (37.3%), with SLE-related death as the next most frequent cause (22.0%). In comparison with earlier data, the proportion of SLE-related deaths has fallen and the proportion of infections has risen. SLE-related death was the most frequent cause of early death, while infection was the most common cause of death in the overall population. In univariate analysis, damage related to SLE, cumulative glucocorticoid dose, mean glucocorticoid dose for 1?month before death, intravenous methylprednisolone therapy and cyclophosphamide treatment were associated with death (p?相似文献   

Mortality related to cerebrovascular disease in systemic lupus erythematosus

The objective of this study was to examine mortality rates related to cerebrovascular disease in systemic lupus erythematosus (SLE) compared to the general population. Our sample was a multisite Canadian SLE cohort (10 centres, n = 2688 patients). Deaths due to cerebrovascular disease were ascertained by vital statistics registry linkage using ICD diagnostic codes. Standardized mortality ratio (SMR, ratio of deaths observed to expected) estimates were calculated. The total SMR for death due to cerebrovascular disease was 2.0 (95% confidence interval [CI] 1.0, 3.7). When considering specific types of events, the category with the greatest increased risk was that of ill-defined cerebrovascular events (SMR 44.9 95% CI 9.3, 131.3) and other cerebrovascular disease (SMR 8.4, 95% CI 2.3, 21.6). Deaths due to cerebral infarctions appeared to be less common than hemorrhages and other types of cerebrovascular events. Our data suggest an increase in mortality related to cerebrovascular disease in SLE patients compared to the general population. The large increase in ill-defined cerebrovascular events may represent cases of cerebral vasculitis or other rare forms of nervous system disease; alternately, it may reflect diagnostic uncertainty regarding the etiology of some clinical presentations in SLE patients. The suggestion that more deaths are attributed to cerebral hemorrhage, as opposed to infarction, indicates that inherent or iatrogenic factors (eg, thrombocytopenia or anticoagulation) may be important. In view of the paucity of large-scale studies of mortality attributed to neuropsychiatric outcomes in SLE, our findings highlight the need for additional research in large SLE cohorts.     

Systemic lupus erythematosus within the first two decades of life

Forty-nine patients with systemic lupus erythematosus (SLE) during childhood and adolescence presenting over a period of 17 years were followed during treatment with prednisone and azathioprine. The average period of follow-up was 5.7 years. Detailed analyses of clinical parameters of renal function and sequential changes in glomerular abnormalities by percutaneous renal biopsy are reported. Therapy was directed towards normalizing the results of urinalysis and renal function, eliminating proteinuria and maintaining normal serology (normal serum complement and negative antiDNA titers). The 10 year survival of the entire group was 86 per cent. A survival of 73 per cent and 87 per cent over this interval in patients with diffuse and focal proliferative lupus nephritis, respectively, was achieved. The major cause of mortality in this series was infection. It appears that intensive observation and monitoring of serologic parameters in SLE, along with aggressive steroid and immunosuppressive therapy, lead to a prognosis in SLE more favorable than previously reported.