育龄期男女系统性红斑狼疮患者临床特点比较

A clinical analysis of male and female patients with systemic lupus erythematosus in child-bearing age

目的 对育龄期男女SLE患者临床特点进行研究.方法 由各参研单位根据统一方式收集病历资料,总结江苏省1999-2009年间住院1 956例SLE患者的临床资料,比较育龄期男性和女性患者的临床表现、免疫学指标、疾病活动度、死亡等指标.统计学处理组间的计数资料比较采用χ^2检验,非正态分布的定量资料比较采用秩和检验.结果 1 839例SLE患者纳入研究范围,其中男性117例,女性1 722例,通过对照研究,男性患者发病年龄[（32±12）岁]、住院年龄[（36±12）岁]晚于女性[（30±10）岁和（33±10）岁]（χ^2=-2.151,χ^2=-2.177,P＜0.05）,男性患者更易出现浆膜炎、肝脾淋巴结肿大、血清ALT及血清肌酐异常（P＜0.05）,而女性患者更易出现关节炎、贫血、抗dsDNA抗体阳性（P＜0.05）;男性患者病死率13.68％（16/117）高于女性患者7.38％（127/1 722）（χ^2=6.064,P＜0.05）,死亡原因分析表明,感染是男女SLE患者死亡的首位原因,其次女性因肾脏累及、肾功能不全死亡,而男性因神经系统累及死亡.结论 育龄期男女SLE患者临床特点有所不同,男性更易出现肝肾功能损害,而女性更易出现关节累及、贫血.男性患者病死率高,预后差.

Objective To analyze the clinical characteristics of male and female patients with systemic lupus erythematosus （SLE） in child-bearing age.Methods Data was collected by the same methods in the past ten years in fifteen hospitals in Jiangsu Province and then it was summarized for retrospective analysis.The difference in clinical manifestations,laboratory features and outcome were analyzed between male and female patients and then the data was analyzed by chi-square test and Wilcoxon rank sum test.Results One thousand eight hundred and thirty nine SLE patients （117 male and 1 722 female patients） were investigated.In the case control study,male patients had an older onset age [（32±12） years old] and hospitalized age [（36±12） years old] than female patients [（30±10） and （33±10） years old] （χ^2=-2.151,χ^2 =-2.171,P 〈0.05）.Male patients had more serositis,general lymphadenopathy/hepatosplenomegaly and fatality rate [male：13.68%（16/117）,female：7.38%（127/1 722）,χ^2=6.064,P〈0.05] while female patients had more arthritis and anemia （P〈0.05）.Male patients had higher frequency of liver function abnormalities and higher serum creatinine （Scr） while female patients had higher anti-dsDNA positivity rate （P〈0.05）.Among the 135 deceased patients,severe infection was the main cause of death in male and female patients,followed by kidney damage in female patients and nervous system damage in male patients.Conclusion Our study suggests that there are major clinical differences between male and female patients with SLE in child bearing age.Male patients have much more severe organ damage than female patients and male patients has higher rate of fatality rate and worse prognostic than female patients.