男性系统性红斑狼疮的临床特点分析

A clinical analysis of male patients with systemic lupus erythematosus

目的探讨男性系统性红斑狼疮（SLE）的临床特点。方法对1997年1月至2006年12月收治的325例SLE（男性38例，女性287例）患者进行总结分析，将男性SLE的临床表现及相关实验室检查与女性SLE进行对比分析。结果①在肾外临床表现方面，男性多浆膜腔炎发生率明显高于女性（P〈0．05），而关节痛、蝶形红斑、口腔溃疡、神经精神狼疮的发生率均明显较女性低，非感染性发热、脱发、光过敏、雷诺现象的发生率男女间差异无统计学意义。②在肾脏受损方面，男性患者肾脏损害发生早，以肾损害为首发症状的发生率男性高于女性（P〈0．05），1年内误诊为原发性肾脏病的发生率男性高于女性（P〈0．01）。③在实验室检查方面，男性血小板减少发生率明显较女性高，而抗ENA总抗体、抗Sm抗体、贫血及高1球蛋白血症发生率男性明显较女性低，抗核抗体（ANA）阳性率、抗RNP抗体阳性率、C3降低、红细胞沉降率（ESR）增快及白细胞减少方面两组差异无统计学意义。结论男性SLE以肾损害发生早、误诊率高-肾外临床表现不典型为特点，临床上要注意男性SLE的早期诊断，及时治疗。

Objective To analyze the clinical characteristics of male patients with systemic lupus erythematosus in a cohort of Chinese patients. Methods 325 lupus nephritis patients （38 male and 287 female patients） admitted to our hospital from January 1997 to December 2006 were summarized in this cohort. The difference in manifestations and laboratory features were analyzed between male and female lupus nephritis patients. Results （~） Male lupus nephritis patients had more freqt^ent episodes of serositis （P 〈0.05）, while female lupus nephritis patients more frequently had arthralgia, malar rash, oral ulcers and neuropsychiatric lu- pus. （2） The kidney was involved with early stage of the disease in male patients. The rate of misdiagnosis was higher in male lupus nephritis patients than that of the female patients. （3） The prevalence of ANA positivity and thromhocytopenia was higher in male patients than that of the female patients. The prevance of positive anti-ENA antibody, anti-Sm antibody, anemia and hypergammaglohulinemia was lower in male patients than those of female patients. No difference was found in the presence of positive anti-RNP antibody, hypocom- plementemia, elevated erythrocyte sedimentation rate and leucocytopenia between the two groups. Conclusion The clinical pictures of male systemic lupus erythematosus patients are atypical except for kidney involvement. The kidney involvement of male lupus patients is characterized by the early onset, rapid progression and high rate of misdiagnosis. Physicians should familiar with these differences. Early diagnosis and appropriate treatment are essential for controlling disease progress.