系统性红斑狼疮患者的用药选择及其与肾脏损害相关性的回顾性分析

The analysis of the medication status and its relevance with lupus nephritis in systemic lupus erythematosus ：a retrospective study of 252 patients

目的了解系统性红斑狼疮（SLE）患者用药的基本情况，探讨规范化应用免疫抑制剂治疗的重要性，为改善SLE患者预后提供临床依据。方法采用流行病学现况调查的研究方法，随机调查252例SLE患者，记录患者自发病以来的用药情况，并分析用药以及就诊情况等因素与肾脏损害之间的关系。结果在252例SLE患者中药物治疗以糖皮质激素（99．2％）、免疫抑制剂（75．8％）、羟氯喹（61．5％）为主。免疫抑制剂以环磷酰胺为常用药（75．9％）。应用免疫抑制剂6个月以上的患者仅有128例（50．8％）。因惧怕不良反应而擅自停药仍为患者停用免疫抑制剂、羟氯喹的主要原因。通过单因素及多因素Logistie回归分析表明，规范应用激素、免疫抑制剂、羟氯喹治疗可以显著降低狼疮肾脏损害的发生率；并且应用免疫抑制剂治疗时间超过3个月，其肾损害以及肾功能不全的发生率明显降低（x^2=3．996，P〈0．05；x^2=13．196，P〈0．01），尤其是达到6个月以上的患者，这种差异更加明显（x^2=4．505，P〈0．05；x^2=8．453，P〈0．01）。结论SLE患者治疗主要是应用糖皮质激素联合免疫抑制剂、羟氯喹。尽早及规范应用糖皮质激素联合免疫抑制剂或羟氯喹治疗，可以显著降低狼疮肾脏损害的发生率。

Objective To investigate the medication status of systemic lupus erythematosus （SLE）, as well as to analyze the importance of standardized immunosuppressive therapy and accumulate clinical evidences for improving the prognosis of SLE. Methods Outpatients diagnosed with systemic lupus erythematosus were investigated in People＇s Hospital, The Third Hospital and Affiliated Hospital of Peking University from May to July 2008 were included. Their gender, age at presentation, clinical manifestations, as well as the location of first hospitalization and medication status were analyzed. Results In the study, 252 SLE patients were investigated. The male-to-female ratio was 1：13. The average age at presentation was （29.5±11.5） years old, while the mean course was 4 years. Corticosteroids （99.2%）, immunosuppressant （75.8%） and hydroxychloroquine （61.5%） were the most commonly used drugs in SLE. Cyclophosphamide was the most commonly used immunosuppressant （75.9%）. Only 128 patients （50.8%） were able to use immunosuppressant for more than 6 months. The reasons why patients stop using immunosuppressant and hydroxychloroquine were investigated and we discovered that patients stop the medications only because of fearing of the adverse eftects of the treatment. Standardized corticosteroids dosage, immunosuppressant and hydroxychloroquine could reduce morbidity of lupus nephritis, and furthermore, it was obvious that the morbidity of lupus nephritis could be reduced by using imnmnnsuppressant for more than 3 mouths, as well as renal dysfunction （x^2=3.996, P= 0.046〈0.05; x^2=13.196, P=0.000〈0.01 ）, which would be more sognificant if immunosuppressant was used for more than 6 mouths （x^2=4.505, P=0.034〈0.05;x^2=8.453, P=0.004 〈0.01）. Conclusion In SLE patients, corticosteroids, inununosuppressant and hydroxychlornquine are the most commonly used drugs. Standardized immunosuppressive therapy with corticosteroids and hydroxychloroquine can reduce the mobidity of lupus nephritis significantly.