不同年龄系统性红斑狼疮临床特征分析

Clinical Characteristics of Systemic Lupus Erythematosus in Different Aged Patients

目的探讨不同年龄系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床特征。方法统计分析550例SLE患者(其中老年组102例,成年组415例,儿童组33例)的临床表现和实验室指标,并进行对照。结果老年组女∶男为5.38∶1,成年组女∶男为11.2∶1,儿童组女∶男为7.25∶1;发病到确诊的平均时间老年组长于成年组,儿童组比成年组明显缩短;老年组疲乏、关节痛、体重下降、肌痛肌无力、肺部病变多见。儿童组体重下降、肾损害、皮疹、神经精神症状多见。老年组血沉增快、肝功能损害多见,补体降低、dsDNA阳性率明显低于成年组(P<0.025)。儿童组U1RNP、dsDNA阳性率高,IgG升高、抗Sm阳性率低(P<0.05)。结论老年及儿童SLE的临床表现多不典型,易误诊和漏诊。老年SLE雷诺现象、脱发、肾损害发生率低,病情较轻,预后良好;儿童SLE肾脏损害,神经精神症状较多见,病情重、进展快,预后差。

Objective To investigate the clinical characteristics of systemic lupus erythematosus（SLE）with different ages. Methods Clinical manifestations and laboratory data of 550 patients （The late-onset group have 102, the adult onset group 415, the childhood-onset group 33） with SLE were collected and compared. Results The ratio of female to male was 5.38：1 in late-onset group and 11.2：1 in adult group,7.25：1 in ehildhood group respectively. The average time from onset to diagnosis in late-onset group was longer than that in adult group, shorter in childhoodonset group than that in adult group （ P 〈 0.025）. The late-onset group had a higher prevalence of fatigue, arthritis, weight losing,muscular pain, weakness of muscle and pneumonopathy than adult group. The childhood group had a higher prevalence of weight losing, renal damage, neurologie disorder （ P 〈 0.025）. The increase of ESR and liver damage in late-onset group were more happened,but low complements C3C4 and positive rates of anti-ds-DNA were less frequent（P 〈 0.025）in late-onset group compared with adult. The positive rates of anti-ds-DNA and U1RNP were more happened in childhood group, IgG increase, positive rates of anti-Sm were lower in childhood （ P 〈 0.025）. Conclusion The clinical manifestations of late-onset and childhood-onset SLE are atypical, which can make a wrong diagnosis and missed diagnosis. Raynaud＇ s phenomenon, renal damage and neurologic disorder are less frequent in late-onset group, so the prognosis is favourable. The renal damage and neurologic disorder are often seen in childhood group and the status of illness in childhood group is serious.