晚发性系统性红斑狼疮患者临床分析

Clinical analysis of late-onset systemic lupus erythematosus in Xinjiang

目的探讨新疆地区晚发性发病的系统性红斑狼疮（SLE）的临床特点。方法系统性回顾分析2006年1月至2016年7月在新疆维吾尔自治区人民医院风湿免疫科住院的87例晚发性SLE的临床资料及实验室检查，并与其中的222例非晚发性SLE进行比较。结果（1）87例晚发性SLE组中女男比例为5．7；1．0，222例非晚发性SLE组中女男比例为11．3：1．0；（2）晚发性SLE组中有13例（14．9％）有诱发因素，11例为感染（12．6％）；非晚发性SLE组有27例（12．2％）有诱发因素，除感染外还有妊娠、流产、日晒等因素；（3）晚发性SLE组中常见的临床表现有：关节炎55例（63．2％），乏力35例（40．2％），皮疹32例（36．8％），食欲减退23例（26．4％），气短23例（26．4％）；晚发性SLE组较非晚发性SLE组食欲减退发生率高（χ^2=10．157，P=0．001），而脱发发生率低（χ^2=16．96，P=0．000），差异均有统计学意义。（4）晚发性SLE组转氨酶升高（χ^2=4．619，P=0．032）、肌酐升高（χ^2=8．365，P=0．004）、血小板下降（χ^2=6．183，P=0．013）较非晚发性SLE组高，差异均有统计学意义，而抗Sm抗体阳性率（χ^2=8．012，P=0．005）、抗Acl抗体阳性率（χ^2=5．459，P=0．019）低于非晚发性SLE组，差异均有统计学意义。（5）汉族晚发性SLE组较维吾尔族、哈萨克族等少数民族晚发性SLE组口腔溃疡发生率高（31．7％／7．4％），差异有统计学意义（χ^2=5．984，P=0．014），而在实验室指标之间无明显差异。结论新疆地区老年发病的SLE男性比例较非晚发性SLE组高，汉族晚发性SLE较少数民族晚发性SLE更易出现口腔溃疡，但早期临床症状不典型，特异性抗体阳性率低，在临床工作中应提高警惕，避免误诊及漏诊。

Objective To assess the clinical characteristics of systemic lupus erythematosus （SLE） in the elderly in Xinjiang. Methods As a retrospective study, clinical date and laboratory test results were collected from 87 elderly SLE patients and 222 non-elderly SLE patients （age〈50 years） hospitalized in the People＇s Hospital of the Xinjiang Uygur Autonomous Region from January 2006 to July 2016. Results The female to maleratio was 5.7 ： 1.0 in the older-onset SLE group and the female to male ratio was 11.3 ： 1.0 in the younger-onset SLE group. Of the 13 patients with predisposing factors in the older-onset SLE group（14.9 % ）, 11 had infection （ 12.6 % ）, whereas the 27 patients with predisposing factors in the younger-onset SLE group （12.2 % ）had pregnancy, abortion or insolation, in addition to infection. Arthritis （ 63.2 % ）, weakness （ 40.2 % ）, malar rashes （ 36.8 % ）, anorexia（26.4 % ）, and shortness of breath（26.4 % ） were common clinical manifestations in the olderonset SLE group. The incidence of anorexia in the older-onset SLE group was higher than that in the younger-onset SLE group（P〈0.01）, while the incidence of trichomadesis was lower in the older-onset SLE group than that in the younger-onset SLE group（P〈0.01 ） ; Aminotransferase elevation, creatinine elevation and thrombocytopenia were more common in the older-onset SLE group than in the younger SLE group （P〈0.05）. Lower rates of positive anti-Smanti body and anti-Acl antibody were found in the older-onset SLE group, compared with the younger-onset SLE group （P〈 0.05） ; Han older-onset SLE patients showed higher rates of oral ulcers than older-onset SLE patients of Uygur, Kazak or other ethnic minorities （P〈0.05）. There were no significant differences between Han and Uygur/Kazak patients in laboratory test results. Conclusions The proportion of male SLE patients in the elderly is higher than that in non-elderly SLE patients in Xinjiang. Also, elderly SLE patients are prone to oral ulcers but often do not show typical early clinical symptoms and have low levels of specific antibodies. Therefore, clinicians should pay particular attention to older-onset SLE patients in order to reduce the rates of misdiagnosis and missed diagnosis.