神经精神性狼疮的预后分析

Analysis of prognosis of neuropsychiatric lupus

目的探讨影响神经精神性狼疮预后的因素。方法回顾性分析95例住院患者的临床资料,以死亡为阳性结局,对性别、年龄、病程、并发症,狼疮活动指数,实验室检查和治疗措施等36项指标,进行Logistic回归分析,计算OR值及其95%CI。结果95例神经精神性狼疮患者中23例死亡,占24.21%。单因素分析显示,年龄、器质性脑病、脑血管意外、肾功能不全、肝功能损害、心功能不全、合并感染、SLEDAI>30、MRI阳性、CTX冲击治疗、甲基泼尼松龙冲击治疗和MTX/DXM鞘内注射均与NPLE的预后有关。进一步多因素分析发现,脑血管意外、心功能不全以及SLEDAI>30是神经精神性狼疮死亡的独立危险因素;而规则的CTX、甲强龙冲击治疗和MTX/DXM鞘内注射是保护性因素。结论神经精神性狼疮患者合并脑血管意外、心功能不全、和SLEDAI>30提示预后不良;规则运用CTX、甲强龙冲击治疗和MTX/DXM鞘内注射可以减少死亡,改善预后。

Objective To discuss the factors associated with the prognosis of neuropsychiatric lupus （NPLE）. Methods A retrospective study on 95 neuropsychiatric lupus inpatients was carried out, and death was outcome factor. The observed variables ineluded gender, age, course of disease, complication, systematic lupus erythematosus disease activity index （ SLEDAI）, and other laboratory and therapeutic data. The data were analyzed with the logistic regression. Results 23 patients of the 95 inpatients died , accounted 24.21%. The univariate analysis showed that age, organic brain syndrome, stroke, urinemia, liver dysfunction, heart inefficiency, infection, SLEDAI 〉 30, magnetic resonance imaging positive, pulse cyclophosphamide （CTX） and methylprednisolone therapy, intrathecal dexamethasone and methotrexate were significantly associated with death. While in multivariate analysis, the variables significantly associated with death were stroke, heart inefficiency, SLEDAI 〉 30, plus CTX therapy, methylprednisolone therapy and intrathecal dexamethasone and methotrexate. Conclusion NPLE patients complicated with stroke, heart inefficiency, SLEDAI 〉 30 suggests that there will be an unfavorable prognosis, standardized use of CTX, methylprednisolone therapy and intrathecal dexamethasone/methotrexate can reduce mortality and improve the prognosis.