系统性红斑狼疮五年生存率及预后因素分析

Analysis of 5-year survival rate and prognostic indicators of systemic lupus erythematosus

目的回顾性分析系统性红斑狼疮（SLE）患者5年生存率、死亡原因及影响预后的因素。方法收集我院1998-2005年住院初发的243例SLE患者的临床及血清学资料，并进行随访。用非参数乘积法分析生存率，比例风险模型（Cox参数回归）分析预后因素。结果从诊断时计算SLE患者1、3、5年生存率分别为96％、94％和91％。肾功能衰竭和感染是最常见的死亡原因，其次是神经精神狼疮和肺动脉高压。多因素分析显示诊断时狼疮肾损害和神经精神狼疮是死亡的独立危险因素，而诊断时年龄、性别、血液系统异常、低补体、抗dsDNA抗体阳性、肺损害、心脏损害以及联合免疫抑制剂治疗对存活影响无统计学意义。结论早期诊断及控制SLE脏器损害，同时预防感染，是提高患者生存率的关键。

Objective To analyze the 5-year survival rate, causes of death and prognostic indicators of systemic lupus erythematosus （SLE）. Methods A retrospective analysis was performed on 243 newly diag- nosed SLE patients who were admitted into our hospital from 1998 to 2005. The clinical features and serologic data were studied. Survival rate of SLE patients over time was studied by the Kaplan-Meier method, and prognostic indicators of mortality were studied by Cox proportional hazards models. Results The 1-, 3- and 5-yr survival rate was 96%, 94% and 91%, respectively. Renal failure and infection were the main causes of death, followed by lupus encephalopathy and pulmonary hypertension. Cox regression analysis revealed that lupus nephritis and lupus encephalopathy at the diagnosis were independent risk determinants for mortality. However, age, sex, low C3 level, positive anti-dsDNA antibody, hematological abnormalities, lupus lung involvement and heart damages at diagnosis and immunosuppressant treatment had no strong association with survival. Conclusion Early diagnosis, control of SLE organ damage and infection prevention are critical to improve survival of SLE patients.