绝经后发病的系统性红斑狼疮20例临床分析

Clinical study on the onset of systemic lupus erythematosus in 20 postmenopausal patients

目的 研究绝经后发病的系统性红斑狼疮 (SLE)的临床特点。 方法 从 1992～ 2 0 0 3年住院的女性SLE患者中选出自然绝经至少 1年后发病的患者 (绝经组 ) 2 0例 ,并以同期住院的月经正常的 70例育龄期发病的患者 (育龄组 )和 4 3例男性患者 (男性组 )作为对照组 ,对比 3组间的临床资料。 结果 绝经组患者占女性患者的 2 9% ,其平均发病年龄为 5 5岁 (4 2～ 6 6岁 ) ,5 0～ 5 9岁为14例 (70 % )。常见的临床表现依次是关节炎、疲乏、发热、脱发、颊部皮疹、心脏损害和体重下降 ,而实验异常依次为血沉快、补体C3下降、抗核抗体 (ANA)≥ 1∶80、γ 球蛋白增高和抗RNP抗体阳性。与育龄组相比 ,绝经组体重下降、肌痛和肌无力的发生率均明显增高 (均为P <0 0 1) ,而颊部皮疹和肾损害的发生率明显降低 (分别P <0 0 5和 0 0 1) ,白细胞下降的发生率和ANA阳性率明显降低 (分别P <0 0 5和 0 0 1)。与男性组相比 ,绝经组狼疮活动性指数 (SLEDAI)平均得分明显降低 (P <0 0 5 ) ,肾损害发生率明显降低 (P <0 0 1) ,而疲乏和体重下降的发生率明显增高 (分别P <0 0 1和<0 0 5 ) ,尿蛋白≥ 1 0 g/d的发生率和抗双链DNA(ds DNA)抗体的阳性率明显降低 (分别P <0 0 1和 0 0 5 )。

Objective To study the clinical characteristics of the onset of systemic lupus erythematosus(SLE) in postmenopausal patients. Methods The clinical features and prognosis of 20 SLE patients whose onset was at least one year after menopause,and 70 patients with the onset during normal menstruation and 43 male patients between 1992 and 2003 were comparatively analyzed. Results The onset of SLE was seen after menopause in 20 out of 699 (2.9%) female patients. The average age at the onset of the disease was 55 years with a peak from 50 to 59. The common clinical manifestations were arthritis,lassitude,fever,alopecia,malar rash,cardiac impairment and weight loss,while laboratory abnormalities were high ESR,decreased C3,ANA≥1∶80,hypergammaglobulinemia and positive anti-RNP antibody. As compared with normal menstruation onset group,the postmenopausal onset group was more likely to have weight loss( P <0.01),myalgia and myasthenia( P <0.01),and less malar rash( P <0.05),renal involvement( P <0.01),decreased leucocytes( P <0.05) and positive ANA( P <0.01). A lower incidence of renal impairment( P <0.01) and positive anti-dsDNA antibody( P <0.05) was found in the postmenopausal onset group compared with the male SLE group while the incidence of lassitude ( P <0.001) and weight loss( P <0.05) were increased. The mean score of SLE disease activity index (SLEDAI) was significantly lower in the postmenopausal onset group compared with male SLE group. Conclusions The postmenopausal onset of SLE patients could be less severe and has a better prognosis.