系统性红斑狼疮男性患者临床及免疫学特征

Clinical and Immunological Manifestations of Male Patients with Systemic Lupus Erythematosus

目的分析142例男性系统性红斑狼疮(SLE)患者起病时首发及发病过程中临床表现特征、自身抗体分布以及其他实验室指标改变特征,探讨SLE男性患者的临床及免疫学特征。方法收集1994年4月至2010年4月于本院风湿免疫科住院的男性SLE患者142例,年龄12～68岁,平均年龄31.9岁;同期住院女性SLE患者320例,年龄12～67岁,平均年龄33.7岁。统计起病时首发症状、进展期临床表现、自身抗体分布、免疫学改变,总结男性SLE特点。结果起病时男性SLE患者首发症状中以发热(58.5%)、口腔溃疡(27.5%)、乏力(42.3%)、关节炎/痛(39.4%)为常见,其中发热、口腔溃疡发生率明显高于女性组,关节炎/痛、脱发、皮疹、光敏感、乏力、淋巴结肿大发生率明显低于女性组,两组比较差异均有统计学意义(P<0.05)。男性SLE患者血液系统受累者为59.9%,肾受累者为71.8%,明显高于女性组,特别是血小板减少(39.4%)及尿蛋白增加(65.0%)者明显高于女性组,两组比较差异有统计学意义(P<0.05)。男性SLE患者抗核抗体(ANAs)阳性率为100%,抗双链DNA(ds-DNA)抗体阳性率为77.5%,与女性组比较差异无统计学意义。男性组抗史密斯(Sm)抗体(32.3%)及抗干燥综合征A(SSA)抗体(13.7%)阳性率显著低于女性组,两组比较差异有统计学意义(P<0.05)。C3减低的发生率男性组为77.5%,女性组为56.5%,明显高于女性患者,两组比较差异有统计学意义(P<0.05)。结论男性SLE患者首发症状、临床表现、自身抗体分布及免疫学改变有自身特点,诊断及治疗时应给予重视。

Objective To analyze the clinical manifestations of the onset of the disease,distribution of antibodies and other laboratory tests in a cohort of 142 male patients with systemic lupus erythematosus（SLE）.Methods 142 male SLE patients who had been treated in our hospital between April 1994 and April 2010 were collected in our study.Their age ranged from 12 to 68 with the mean age of 31.9 years old.320 female SLE patients whose age ranged from 12 to 67 with the mean age of 33.7 in the same hospitalized time were collected,too.The initial symptoms,clinical manifestations in the advanced phase,distribution of antibodies and immunological changes were reviewed to show the characteristic of male SLE patients.Results In male SLE patients,fever（58.5%）,fatigue（27.5%）,arthritis/arthralgia（39.4%） were commonly seen as initial symptoms.And the incidence of fever and oral ulcer in male was obviously higher than that in female.But arthritis/arthralgia,alopecia,rash,photosensitivity,fatigue and lymph node enlargement were less common in male patients.There was statistical difference between the two groups（P0.05）.Hematological changes were observed in 59.9% of the patients and 71.8% patients had renal damanages.These manifestations in male patients were more frequent than those in female patients,particularly thrombocytopenia and proteinuria（39.4%）.The positive rate of anti-nuclear antibodies（ANA）and anti ds-DNA antibodies was 100% and 77.5% respectively.There was no difference between the two groups.The positive rate of anti Sm and anti SSA antibodies in male patients was lower than that of females and there was statistical difference between the two groups（P0.05）.Male patients with the decrease of complement C3 were more than that of female patients and there was significant difference between the two groups（P0.05）.Conclusion There are significant differences in the initial symptoms,clinical manifestation,distribution of antibodies and immunological changes between male and female SLE patients.These difference should be considered in the strategy of diagnosing and treating SLE patients.