老年发病系统性红斑狼疮患者临床特点分析

Analysis on clinical features of elderly-onset systemic lupus erythematosus

目的回顾性分析老年发病系统性红斑狼疮（SLE）住院患者的临床特征。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916例初诊住院SLE患者的临床资料，根据发病年龄分为老年组（年龄≥60岁）及对照组（年龄〈60岁），分析不同年龄SLE患者临床表现、免疫学指标及疾病活动之间的关系。结果纳入研究范围的916例SLE患者中，老年组24例，对照组892例。老年组男性占比例、病死率较高，并发症多；盘状红斑、血小板减少、C反应蛋白（CRP）增高、血清白蛋白异常均较对照组多见（P〈0．05）；而颊部红斑、光过敏较对照组少见；抗核抗体阳性率、抗Sm抗体阳性率较对照组低（P〈0．05）；疾病确诊时间、发病至死亡平均年限、阳性家族史、口腔溃疡、关节炎、浆膜腔积液、神经精神系统、肌肉骨骼系统、肾脏受累、白细胞减少、贫血、血清肌酐异常、尿蛋白异常、红细胞沉降率（ESR）、抗dsDNA抗体阳性率、低补体C3、人院SLEDAI评分方面比较，两组差异无统计学意义。结论老年发病SLE患者与早发病SLE患者临床表现存在多种差异，病死率高，须提高警惕。

Objective To retrospectively analyze the clinical features of elderly-onset systemic lupus erythematosus （SIZE）. Methods A total of 916 patients were enrolled in this retrospective study, and their clinical data were collected by the same methods in the past ten years （1999-2009） in fifteen hospitals in Jiangsu Province. Patients were divided into two groups based on the age of onset disease： control group and elderly group. The relationships between clinical features, immunology index and disease activity were analyzed in different age group. Results Among 916 SIzE patients, 24 patients were selected in the elderly onset SLE group, and 892 patients were considered as the control group. The ratio of male/female, mortality rate, the number of complications were higher in elderly onset SI.E group than those in the control group （all P〈 0.05）, and discoid rash, thrombocytopenia, elevated C-reactive protein （CRP） level, abnormality of serum albumin were found more common in elderly onset SLE group than in control group （all P〈0.05）. The incidences of Malar rash and photosensitivity, antinuclear antibodies （ANA） positivity rate, anti-Sm antibodies positivity rate were lower in elderly onset SLE group than in control group （all P〈0.05）. The time of final diagnosis, mean time of onset to death, positive family history, oral ulcers, arthritis, serositis, nervous involvement, musculoskeletal disorder, renal involvement, elevated serum creatinine （Scr） level, leucopenia, hemolytic anemia, elevated proteinurine, Erythrocyte Sedimentation Rate （ESR） levels, anti dsDNA antibodies positivity rate, decreased complement C3 level, SLEDAI score had no significant differences between the two groups. Conclusions There were many differences in the clinical features between the elderly onset SLE patients and the controls, and the mortality rate is higher in the elderly onset SLE patients, which should be pay more attention to in clinical medcine.