重症系统性红斑狼疮患者中西医临床特征分析

Analysis of Clinical Characteristics of Chinese and Western Medicine in Patients with Severe Systemic Lupus Erythematosus

目的研究重症系统性红斑狼疮(SSLE)患者中西医临床特征,并对死亡病例资料进行分析。方法收集广东省中医院2011年1月—2017年12月间SSLE住院患者的临床病例资料,采用回顾性研究方法对纳入的SSLE患者性别、年龄、临床症状、脏器受累情况、中医证候、舌象、脉象及死亡率、死因等进行统计分析。结果共纳入349例SSLE患者,男女比例为1:5.35,15~35岁为高发年龄,性别与不同年龄段(14岁、15~35岁、36~60岁及61岁)的发病率之间比较,差异有统计学意义(χ^(2)=9.750,P=0.021);肾脏、神经系统、血液系统、肺脏受累的人群多见于15~35岁患者,心脏、消化系统受累的人群多见于36~60岁患者;排名前5位的中医证候分别为脾肾亏虚、湿瘀内结、湿热内结、气阴两虚、脾虚夹湿,实证分别为:瘀、湿、热、痰、浊,虚证分别为:脾虚、肾虚、气虚、阴虚、阳虚;排名前5位的舌质为淡暗、红、暗红、淡红、淡白,舌苔为白腻、薄白、黄腻、薄黄、少苔,脉象为细、数、沉、滑、弦。患者死亡率为6.02%(21/349),男:女为1:4.25,男女患者死亡率之间差异无统计学意义(χ^(2)=0.014,P>0.05);50岁以上患者死亡率较高,感染、恶性肿瘤是其主要死因,其次为狼疮性脑病、急性心肌梗死;50岁以下患者主要死因亦为感染,其次是狼疮性肾炎。结论SSLE高发于中青年人群,死亡率较高,患者常伴有多个重要脏器/系统受累,中医证候以脾肾两虚、瘀湿内结等虚实夹杂证为主要表现,感染、恶性肿瘤及狼疮活动是主要死因。

Objective To investigate the clinical characteristics of Chinese and Western medicine in patients with severe systemic lupus erythematosus(SSLE).Methods Clinical data of SSLE inpatients in Guangdong Provincial Hospital of Chinese Medicine from January 2011 to December 2017 were collected.The gender,age,clinical characteristics,organ damage,Chinese medicine syndrome,tongue and pulse manifestation,mortality and cause of death were statistically analyzed by retrospective study.Results A total of 349 patients with SSLE were recruited,the ratio of male to female was 1∶5.35,and the age of high incidence was 15 to 35 years old.The differences of morbidity between gender and age(14,15~35,36~60 and 61 years old)were statistically significant(χ^(2)=9.750,P=0.021).Kidney,nervous system,blood system and lung damage were most common in patients aged 15 to 35,while heart and digestive system damage were common in patients aged 36 to 60.The top 5 Chinese medicine syndromes were deficiency of Pi and Shen,amassment of dampness-blood stasis,amassment of dampness-heat,deficiency of qi and yin,dampness stagnancy due to Pi deficiency.The mainly excess syndrome were stasis,dampness,heat,phlegm and turbidity,and the mainly deficiency syndromes were Pi,Shen,qi,yin and yang deficiency.The top 5 tongue body were light dark,red,dark red,light red and light white.The top 5 tongue fur were white-greasy,whitethin,yellow-greasy,yellow-thin and little.The top 5 pulse were thread,rapid,deep,slippery and stringy.The mortality rate was 6.02%(21/349),the ratio of male to female was 1:4.25.The differences of mortality between male and female patients were not statistically significant(χ^(2)=0.014,P>0.05).The patients over 50 years old had a higher mortality,and infection and malignant tumor were the leading causes,followed by lupus encephalopathy and acute myocardial infarction.Infection was also the main cause of death in patients under 50 years old,followed by lupus nephritis.Conclusions SSLE has a high morbidity rate among young and middleaged people and the mortality rate of this disease is high.Patients often have multiple vital organs/systems damage.The Chinese medicine syndrome is mainly manifested as intermingled deficiency and excess,of which Pi-Shen deficiency mixed with amassment of dampness-blood stasis is the most common pattern.Infection,malignant tumor and lupus activity are the main causes of death.