重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

来氟米特对狼疮肾炎患者外周血单个核细胞分泌细胞因子谱的影响

目的:了解来氟米特对狼疮肾炎(lupus nephritis,LN)患者外周血单个核细胞分泌细胞因子水平(IL-12,IFN-r,IL-4和IL-6)有无影响.方法:取受试者空腹静脉血15 mL,肝素钠抗凝,提取PBMCs,分组培养,健康对照:空白培养,植物血凝素(PHA)刺激培养;LN组:空白培养,PHA刺激培养,PHA+来氟米特体内活性产物(A771726)培养.ELISA检测健康对照和LN患者PBMCs培养上清液的细胞因子IL-12.IFN-r,IL-4和IL-6水平.多组均数问比较采用单因素方差分析.结果:符合入选条件中重度LN患者10例和健康对照9例,全部女性.与健康对照组相比,不论有无PHA刺激,LN患者PBMCs分泌Th1型细胞因子(IL-12,IFN-r)和Th2型细胞因子(IL-4,IL-6)水平均明显升高;与无A771726处理培养的LN患者PBMCs相比,不论有无PHA刺激,经A771726处理培养LN患者PBMCs分泌IL-12、IFN-r、IL-6水平均显著降低,但IL-4水平无明显改变.结论:LEF可明显下调LN患者PBMCs分泌IL-12、IFN-r、IL-6水平可能是其有效治疗LN的又一重要机制.     

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.     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

重症监护病房系统性红斑狼疮患者预后因素分析

Objective To analyze the outcomes and prognostic factors associated with the death of systemic lupus erythematosus (SLE) patients admitted to the intensive care unit (ICU). Methods During June 1996 to June 2007, all SLE patients admitted to the ICU were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using variables that were associated with death in the univariate analysis. Results A total of 101 patients meeting the criteria were included. The mortality rate was 48.6%. The most common causes of admission was lung disorder with acute respiratory distress syndrome (ARDS). Multivariate logistic regression analysis suggested that SLICC/ACR DI>7.7 (OR=6.87), APACHE Ⅲ≥21 (OR=29.8), lung disorders with ARDS (OR =55.81 ), septic shock (OR =32.22 ), intracranial haemorrhage (OR =57.35 ), hypocytopenia (OR = 5.89), mean equivalent prednisone dose>25 mg/d (OR=7.65) and prolonged tracheal intubation (OR=5.98) were signi-ficantly associated with death. Whereas sex, age, SLEDAI >27, gastrointestinal bleeding, the cumulative dosage of CTX higher than 1.0 g, pulse intravenous methylprednisolone therapy were not associated with death. Conclusion The mortality rate of critically ill SLE patients in ICU is very high. SLICC/ACR DI> 7.7, APACHE Ⅲ≥21, lung disorders with ARDS, septic shock, intracraniai haemorrhage, average prednisone equivalent dosage higher than 25mg/d and prolonged tracheal intubation (longer than 4 days) are negative prognostic factors in SLE patients admitted to the ICU.     

系统性红斑狼疮患者外周血B细胞脂筏及细胞骨架蛋白的表达初探

目的 了解系统性红斑狼疮(SLE)患者外周血B细胞脂筏及细胞骨架蛋白的表达及分布.方法 密度梯度离心法分离SLE和健康对照者外周血单个核细胞,磁珠分选纯化B细胞.用异硫氰酸荧光素(FITC)标志的霍乱毒素B亚单位(CTB)对B细胞脂筏染色,流式细胞仪及激光共聚焦显微镜分析;用罗丹明标志的鬼笔环肽对B细胞骨架蛋白染色,激光共聚焦显微镜观察.并设空白对照组、来氟米特组干预培养活动期SLE患者B细胞4h,流式细胞术检测B细胞脂筏的改变.同时记录受试患者的临床资料SLE疾病活动指数(SLEDAI).计量资料进行方差分析或配对t检验,相关性分析采用Pearson法分析.结果 SLE活动组、治疗缓解组CTB-FITC与外周血B细胞脂筏结合率较健康对照组明显增高[(59±4)％,(51±5)％,(33±4)％,F=9.21,P=0.001].共聚焦显微镜观察B细胞脂筏及骨架蛋白的分布及表达时发现,在健康对照组中,脂筏主要均匀分布于B细胞膜中,散在出现小范围聚集;骨架蛋白主要分布于B细胞的外层.而在SLE组中,B细胞脂筏可出现表达和分布的异常,呈现细胞膜荧光染色厚度的增加、聚集范围扩大及荧光强度的增强;同时伴随着B细胞膜骨架蛋白染色荧光强度的减弱.在SLE活动组中,患者外周血B细胞脂筏表达水平与其SLEDAI呈正相关(r=0.632,P=0.028).并且,与空白对照相比,干预培养后来氟米特能降低CTB与活动期SLE患者B细胞脂筏结合率[(48±5)％和(39±5)％,t=2.29,P=0.048)].结论 SLE患者外周血B细胞脂筏和骨架蛋白的表达和分布存在异常,B细胞脂筏和骨架蛋白表达的调节可能在治疗SLE中具有一定的作用.