系统性红斑狼疮预后因素Cox回归分析

Prognostic indicators for systemic lupus erythematosus analyzed by Cox proportional hazards model

目的分析系统性红斑狼疮（SLE）预后影响因素及死亡原因。方法建立1999--2009年在南京大学医学院附属鼓楼医院风湿免疫科首次住院治疗并经电话随访319例患者临床资料库，服从正态分布的计量资料采用x±s进行描述，偏态分布资料采用中位数（四分位数间距）进行描述，以率或构成比描述分类资料特征。用非参数乘积法分析生存率，比例风险模型（Cox回归）分析预后因素。结果从确诊时计算SLE患者5、10年生存率分别为：96．2％、88．7％；影响SLE的预后因素有发病至确诊时间长、贫血、白细胞尿、血浆低白蛋白、低补体、心电图异常、超声心动图异常、合并肺动脉高压（PAH）、SLE疾病活动性指数（SLEDAI），其中合并PAH、发病至确诊时间长、血浆低白蛋白是独立的预后不良影响因素，其相对危险度及95％可信区间（95％CI）分别为2．419（1．052～5．564）、1．162（1．043～1．294）、0．924（0．873～0．978）。肾功能衰竭、肺动脉高压和感染是最常见的死亡原因，其次是神经精神狼疮和多系统器官衰竭。结论合并PAH、发病至确诊时间长、血浆白蛋白降低是影响SLE预后不良的重要影响因素，早期诊断、及时治疗SLE的脏器损害、防止并发症发生是改善SLE预后的关键。

Objective To analyze the prognostic factors and causes of death of patients with systemic lupus erythematosus （SLE）. Methods A database with 319 patients were developed. They were newly diagnosed SLE in the Department of Rheumatology and Immunology, Affiliated Drum Tower Hospital of Nanjing University Medical School from 1999 to 2009. Normal distribution of measurement data was presented using mean ± standard deviation. The skewed distribution of data was described by median （interquartile range）. Using the rate or proportions, the character of classification data was also stated. Survival rate of SLE patients over time was studied by the Kaplan-Meier method, and prognostic factors were analyzed by cox proportional hazards model. Results The 5 year and 10-year survival rates was 96.2%, 88.7%, respectively. Prognostic factors affecting survival included duration from onset to diagnosis, anemia, white blood cells in urine, low serum albumin, low C4 level, abnormal ECG and ultrasound echocardiography, pulmonary arterial hypertension （PAH） and systemic lupus erythematosus disease activity index （SLEDAI）. However, PAH, duration from onset to diagnosis, low serum albumin were the independent poor prognostic factors and the relative risk and 95% confidence interval were 2.419 （1.052-5.564）; 1.162 （1.043-1.294）, 0.924 （0.873- 0.978）, respectively. Renal failure, pulmonary hypertension and infection were the main causes of death, followed by multiple organ failure and lupus encephalopathy. Conclusion PAH, duration from onset to diagnosis, low serum albumin are the important factors predicting poor prognosis. Early diagnosis, timely treatment of SLE organ damages and preventing complications are the key factors to improve the prognosis of patients with SLE.