并发神经精神狼疮的狼疮肾炎患者生存分析

Survival analysis of lupus nephritis with neuropsychiatric systemic lupus erythematosus

目的探讨并发神经精神狼疮（NPSLE）的狼疮肾炎（LN）患者的生存率及其影响因素。方法收集78例并发NPSLE的LN患者的临床及实验室资料，共59个变量。对患者进行随访，随访起点为NPSLE起病，随访终止目标为患者因系统性红斑狼疮（SLE）或其并发症死亡，平均随访时间（53．26~44．32）月。用Kaplan—Meier法计算累积生存率，并以Cox回归模型进行影响因素分析。结果78例患者中16例（20．5％）因SLE或其并发症死亡。感染为最常见的死亡原因，占31．3％。患者1年、3年、5年和10年的累计总生存率分别为83．2％、81．7％、76．7％和76．7％。对生存率有影响的危险性因素为高血压（RR=6．965，95％CI：1．578—30．746，P：0．010）、肺部感染（RR：8．171，95％C1：1．954～34．177，P=0．004）及急性肾衰竭（RR=6．978，95％CI：2．063～23．609，P=0．002）；保护性因素为环磷酰胺（CTX）冲击治疗（RR=0．130，95％CI：0．031—0．541，P=0．005）和NPSLE治疗缓解（RR=0．169，95％CI：0．042～0．679，P=0．012）。结论感染是并发NPSLE的LN患者最常见的死亡原因。并发NPSLE的LN患者的生存率低于单纯发生LN或NPSLE患者的生存率。高血压、肺部感染及急性。肾衰竭是死亡的危险因素；CTX冲击治疗和NPSLE治疗缓解能降低病死率，改善预后。

Objective To investigate the survival rate and the influencing factors in lupus nephritis （LN） patients with neuropsychiatric systemic lupus erythematosus （NPSLE）. Methods Clinical characteristics and biochemical markers of 78 patients including 59 variances were analyzed. Patients were followed up from the onset of NPSLE to death. Patient survival rate was estimated by Kaplan-Meier method. Cox regression model was used to analyze influencing factors. Results Sixteen （20.5%） of 78 patients died of SLE or its complications, Infection was the main cause of death （31.3%）. One-, 3-, 5- and 10-year survival rates were 83.2%, 81.7%, 76.7% and 76.7%, respectively. Hypertension （RR =6.965,95%CI：1.578-30.746, P= 0.010）, pulmonary infection （RR =8.171,95% CI： 1.954-34.177, P=0.004）and acute renal failure （RR=6.978,95%CI： 2.063-23.609, P=0.O02） were risk factors of mortality, while cyclophosphamide （CTX） impulse therapy（RR=O.130,95%CI：0.031-0.541, P=0.005） and resolution of NPSLE（RR= 0.169, 95%CI： 0.042-0.679, P=O.012）were protective factors. Conclusions Infection is the main cause of death in patients of LN complicated with NPSLE. Survival rate of LN patients with NPSLE in this study is lower than those of LN and NPSLE alone reported by other authors.Hypertension, pulmonary infection and acute renal failure are risk factors of mortality, while CTX impulse therapy and resolution of NPSLE reduce the mortality and improve the prognosis.