狼疮性肾炎患者56例死亡原因及危险因素分析

Analysis of Risk Factors and Causes of Mortality in 56 Patients with Lupus Nephritis

目的:分析狼疮性肾炎(LN)患者的死亡原因及危险因素,探讨减少死亡率的策略。方法:以2003年1月-2012年12月我院住院期间死亡的LN患者56例为研究组,并与同期住院存活的LN患者129例为对照组,比较两组的临床特点、死亡原因和死亡危险因素。结果:LN患者第一位死亡原因为SLE本身(53.5%),其次为感染(21.4%)及心血管疾病(17.9%);与对照组比较,研究组患者的急性肾损伤、慢性肾衰竭进入透析、狼疮脑病、浆膜炎及感染等的发生率明显高于对照组(P<0.05或0.01);狼疮脑病、慢性肾衰竭、SLEDAI升高是LN患者死亡的独立危险因素(OR>1,P<0.05),体重指数(BMI)是LN的保护因素(OR<1,P<0.05)。结论:SLE本身所致多器官功能衰竭是LN的主要死亡原因,采取合理治疗措施,控制狼疮活动,积极治疗狼疮脑病、慢性肾衰竭,防止感染、纠正营养不良,可能有助于降低LN患者的病死率。

Objective： To define the causes and associated risks of death and to investigate methods to reduce mortality of patients with lupus nephritis （LN）. Method： 56 patients with LN died during hospitalization from Jan 2003 to Dec 2012 were classed as research group,while 129 patients with LN surviving of the presidium were selected as control group. The clinical characteristics, causes of death and potential risk factors were compared between the two groups. Results：Among the 56 cases, the leading causes of death were SLE itself （53.5%）, infection （21.4%） and cardiovascular disease （17.9%）. The incidence of AKI, chronic renal failure in dialysis, lupus encephalopathy, serositis and infection were significantly higher in research group than those in the control group （P 〈 0.05 or 0.01）. Lupus encephalopathy, chronic renal failure and higher SLEDAI were the independent risk factors of death （OR〉1 ,P 〈 0.05）, BMI was the protective factor（OR〈l ,P 〈 0.05）. Conclusion：The leading cause of death of patients with LN is associated with the multiple organ dysfunction caused by SLE. It may reduce the mortality rate by controlling lupus activity, lupus encephalopathy, and chronic renal failure, preventing the infection and correcting the malnutrition.