系统性红斑狼疮病情活动相关因素的研究

目的 探讨引起系统性红斑狼疮(SLE)病情活动的相关因素。方法 采用回顾性前瞻研究的方法,对132例SLE患者追踪随访1～5年,先将研究变量运用单因素非条件Logistic回归分析方法进行研究,再将有意义的变量进行多因素非条件Logistic回归分析。结果 132例患者中有82例出现115次复发,每人年复发0.22次。在确诊后5年内出现复发的频数较确诊后5年以上者高。采用单因素非条件Logistic回归分析显示:入选年龄<40岁、发病年龄<32岁、负性生活事件的应激、抑郁、劳累、妊娠、患感染性疾病、糖皮质激素减量过快等对复发的影响有显著性意义(P<0.05);而绝经、定期检查、使用维持量糖皮质激素对SLE的复发有保护作用,其影响也有显著性意义(P<0.05)。进一步对上述有临床意义的变量进行多因素Logistic回归分析,结果显示,糖皮质激素减量过快(OR=6.85)、确诊年龄小(OR=5.03)、患感染性疾病(OR=4.24)、劳累(OR=3.41)、负性生活事件的应激(OR=2.70)是影响复发的重要相关因素,其统计结果差异有显著性(P<0.05);而绝经(OR=0.14)是SLE患者病情复发的保护性相关因素,其统计结果有显著性意义(P<0.05)。结论 糖皮质激素减量过快、确诊年龄小、患感染性疾病、劳累、负性生活事件的应激是引起SLE病情活动重要因素,医生应指导患者趋利避害,以减少SLE复发。

Study on the Risk Factors of Flare in Systemic Lupus Erythematosus

Objective To investigate the risk factors of flare in systemic lupus erythematosus(SLE).Methods In this retrospective cohort study 132 cases of SLE were followed up for 1～5 years.The risk factors of SLE flare were analyzed by univariate and multivariate logistic regression with computer software,SPSS.Results Of the 132 patients,82 cases had more than one flare,the total number of flares was 115.The incidence of flare was 0.22 per patient-year.The frequency of flares within 5 years after diagnosis of SLE was higher than that in more than 5 years.By univariate logistic regression analysis the age younger than 40 years at the beginning of the study,age of disease onset younger than 32 years,stress,depression,overwork,pregnancy,suffering from infectious disease,and quick decreasing of prednisone dosage significantly increased the risk of flare(P<0.05),while menopause,regular follow up,and receiving maintenance dose of prednisone therapy decreased the risk of flare.By multivariate logistic regression analysis the quick decreasing of prednisone dosage(OR=6.85),younger age of onset of the disease(OR=5.03),infectious disease(OR=4.24),overwork(OR=3.41),stress(OR=2.70)were independent risk factors for SLE flare(P<0.05),while menopause(OR=0.14)decreased the risk of SLE flare(P<0.05).Conclusions The quick decreasing of prednisone dosage,younger age of disease onset,infectious disease,overwork,stress were important risk factors for SLE flare.The SLE patients should be advised to avoid these risk factors in order to prevent from disease flare.