48例晚发型系统性红斑狼疮的临床分析

Clinical Features in Patients With Late-Onset Systemic Lupus Erythematosus

目的:分析48例晚发型系统性红斑狼疮患者的临床特征。方法:回顾性分析1995年7月～2008年6月间解放军174医院及解放军175医院住院及门诊的48例发病年龄≥50岁的SLE患者的年龄、性别、诊断时间、临床表现及诊治经过等特点,并与随机抽取的同期100例发病年龄<50岁的SLE患者进行比较。结果:晚发组女性与男性患者的比例显著低于对照组(P<0.01);发病至确诊的间隔时间略长于对照组,但差异尚无统计学意义。晚发组关节炎、蝶形红斑发生率显著低于对照组(P<0.01,P<0.05),而发热、高血压发生率略高于对照组,但差异无统计学意义;晚发组重要脏器受累较少(P<0.05),肾衰竭的发生率较低(P>0.05),增生性狼疮性肾炎的发生率低于对照组(P<0.05),尤其是弥漫增生性肾炎的发生率更低(P<0.01);晚发组平均每个病人的严重复发次数少于对照组(P<0.01);晚发组低补体血症较少见(P<0.01),而类风湿因子阳性率高(P<0.05);晚发组需要接受大剂量糖皮质激素(P<0.01)及免疫抑制剂(P<0.01)治疗的患者较少。结论:晚发型SLE患者病情相对较轻,较少出现严重复发,但易误诊,临床医师应加强对这一类型SLE的认识。

Objective：This study was undertaken to compare retrospectively the clinical and laboratory features between early and late onset SLE patients in a Chinese population. Methods： Case records of all SLE patients who attended our clinics between 1995 and2008 were reviewed. Patients with a disease onset beyond the age of 50 years were identified. One hundred consecutive SLE patients who had their disease onset before the age of 50 were recruited as controls. The presenting clinical features, autoantibody profile, number of major organs involved, number of major relapses, and the use of cytotoxic agents in the two groups of patients were obtained and compared. Results：48 patients with late onset SLE were identified. The female to male ratio was 2.7 to 1, compared with 13 to 1 in the control group （P〈0.01）. There were no significant differences in the clinical features between the two groups except for a lower prevalence of malar rash （ P 〈 0.05 ）, arthritis（ P 〈 0.01 ）, major organs involved （ P 〈 0.05 ）, Low serum complement Levels（ P 〈 0.01 ） and a higher prevalence of rheumatoid factor （ P 〈 0.05 ） in the late onset patients. On subsequent visits, the late onset group had fewer major relapses （P〈 0.01 ） and required fewer highdose corticosteroids（ P 〈 0.01 ） and cytotoxic agents for disease control （P〈0.01）. Conclusion： Late onset SLE in Chinese tends to run a more benign course with fewer major organ involvement and fewer major relapses.