系统性红斑狼疮发病及就诊相关因素分析

Related factors of systemic lupus erythematosus：clinical analysis of 203 cases

目的探讨系统性红斑狼疮（SLE）患者发病相关因素及发病后就诊情况。方法随访203例SLE患者，其中女192例，男11例，男女之比为1：17，平均发病年龄（32±14）岁，平均病程3年，了解其发病前的各种相关诱因、家族史、发病后诊断及用药情况等，并进行统计学分析。结果因发病前曾经有劳累病史的患者63例，有先驱感染病史的患者47例，分别占调查者的31．0％和23．2％；日晒、情绪波动、月经紊乱、流产、染发、接触化学药物，分别占调查者的14．3％、14．3％、9．4％、6．9％、4．9％和1．5％；16例患者（7．9％）有阳性家族史；首诊即明确诊断的患者有120例，占调查人数的59．1％；另有83例患者误诊，其中23．2％的患者发病1年后仍没有得到正确诊断，误诊最长时间为14年；69．0％的患者确诊后首次用药选择糖皮质激素及免疫抑制剂，19．2％首选中药或者偏方治疗；发病后128例患者不能正常工作。结论SLE患者女性多发，劳累、感染、日晒、情绪波动等因素与SLE发病中有一定的相关性，诱发因素多种多样；发病后不能及时得到正确诊断和治疗的SLE患者仍占相当大比例；SLE影响患者生活质量的情况较严重。

Objective To investigate the related factors of systemic lupus erythematosus （SLE） and the situation of diagnosis and treatment after onset. Methods 203 SLE patients, 11 males and 192 females, with a male/female ratio of 1 ： 17, average onset age of （ 32 ± 14 ） , and average course of 3 years, were followed up and the related factors such as risk factors, family history and the situation of diagnosis and treatment were studied. Results 63 patients （31%） had the history of overworking before falling ill; 47 patients （23.2%） had suffered from infection before SLE onset. Other risk factors, such as solarization, emotional fluctuation, menstrual disorder, abortion, dyeing, and chemical drug contacting accounted for 14. 3% , 14. 3%, 9. 4%, 6. 9% , 4. 9% , and 1.5% respectively. 16 patients （7.9%） had positive family history. 120 patients got the correct diagnosis at the first visit. 83 patients had been misdiagnosed for less than 1 year to 14 years. 47 of the 83 patients （23.2%） failed to get the correct diagnosis for more than one year. 140 of the 203 patients （69. 0% ） were given glucocorticoid and/or immunosuppressant as the first choice treatment measures after the diagnosis was confirmed. 39 of the 203 patients （19.2%） chose traditional Chinese medicine or folk prescription as the first choice. And 24 of the 203 patients （ 11.8% ） used anti-inflammatory, and antipyretic drugs. 128 patients （ 63.1% ） failed to continue to work. Conclusion Overworking, infection, solarization, and emotional fluctuation may be related to the onset of SLE. A great part of SLE patients can not be diagnosed early and treated promptly. SLE brings bad influence on the life quality of patients.