临床特征及实验室相关指标与青少年系统性红斑狼疮预后的关系

The relationship between clinical features,laboratory-related indicators and prognosis of juvenile systemic lupus erythematosus

目的研究临床特征和实验室相关指标与青少年系统性红斑狼疮(systemic lupus erythematosus,SLE)预后的关系。方法选取SLE青少年患者145例,随访记录不良预后发生率。比较不同预后患者临床特征和实验室相关指标水平,采用Cox风险模型分析影响青少年SLE不良预后的独立影响因素,根据Cox风险模型分析结果建立预后指数(prognostic index,PI)方程,分析其判断不良预后的价值。结果随访1~10年,中位随访时间(5.85±2.67)年,失访3例,死亡5例,复发32例。不良预后37例,不良预后率25.52%。不良预后组患者雷诺症、肺部感染及眩晕呕吐发生率显著高于对照组,尿红细胞计数(reliable bit cast,RBC)、24 h尿蛋白定量、总胆固醇(cholesterol,Cho)、免疫球蛋白A(immunoglobulin A,IgA)及红细胞沉降率(erythrocyte sedimentation rate,ESR)水平显著高于对照组,补体3(complement 3,C3)、补体4(complement 4,C4)水平显著低于对照组(P<0.05)。Cox风险回归模型分析结果显示雷诺症(β=0.934,HR=2.545,95%CI=1.228~5.274,P=0.012)、神经精神狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)(β=0.806,HR=2.239,95%CI=1.102~4.549,P=0.026)、IgA(β=0.921,HR=2.512,95%CI=1.403~4.498,P=0.002)、24 h尿蛋白定量(β=0.784,HR=2.191,95%CI=1.132~4.241,P=0.020)及C3(β=-0.523,HR=0.593,95%CI=0.402~0.875,P=0.008)是SLE青少年患者不良预后的独立影响因素。根据Cox风险回归模型建立PI方程。受试者工作曲线(receiver operating characteristic,ROC)分析显示PI方程判断青少年SLE不良预后风险的曲线下面积(area under curve,AUC)为0.784(SE=0.091,95%CI=0.606~0.963,P=0.032),敏感度为0.800,特异度0.737。结论青少年SLE患者预后与其临床特征和实验室相关指标有关,据此建立的PI方程对判断患者不良预后具有较高准确性。

Objective To study the relationship between clinical features,laboratory-related indicators and prognosis of juvenile systemic lupus erythematosus(SLE).Methods A total of 145 juvenile patients with SLE were selected,and the incidence of poor prognosis was recorded.The clinical features and laboratory-related indicators of patients with different prognosis were compared.The independent influencing factors for the poor prognosis of juvenile SLE were analyzed by Cox risk model.According to the analysis results of Cox risk model,the prognostic index(PI)equation was established to analyze its value in evaluating the poor prognosis.Results They were followed up for 1-10 years,with the median follow-up of(5.85±2.67)years.Of them,3 cases were lost to follow-up,5 cases died and 32 cases experiened recurrence.In addition,37 cases had poor prognosis,and the poor prognosis rate was 25.52%.The incidence of Raynaud's disease,pulmonary infection,vertigo and vomiting in the poor prognosis group was significantly higher than that in the control group.The levels of reliable bit cast(RBC),24 h urinary protein,total cholesterol(Cho),immunoglobulin A(IgA)and erythrocyte sedimentation rate(ESR)in the poor prognosis group were significantly higher than those in the control group,while the levels of complement 3(C3)and complement 4(C4)were significantly lower than those in the control group(P<0.05).Cox risk regression model analysis showed that Raynaud's disease(β=0.934,HR=2.545,95%CI=1.228-5.274,P=0.012),neuropsychiatric systemic lupus erythematosus(NPSLE)(β=0.806,HR=2.239,95%CI=1.102-4.549,P=0.026),IgA(β=0.921,HR=2.512,95%CI=1.403-4.498,P=0.002),24 h urinary protein quantification(β=0.784,HR=2.191,95%CI=1.132-4.241,P=0.020)and C3(β=-0.523,HR=0.593,95%CI=0.402-0.875,P=0.008)were independent influencing factors for the poor prognosis of juvenile patients with SLE.PI equation was established according to Cox risk regression model.Receiver operating characteristic(ROC)curve analysis showed that the area under ROC curve(AUC)of PI equation to evaluate the adverse prognostic risk of juvenile patients with SLE was 0.784(SE=0.091,95%CI=0.606-0.963,P=0.032),the sensitivity was 0.800 and the specificity was 0.737.Conclusion The prognosis of juvenile patients with SLE is related to its clinical features and laboratory-related indicators.The PI equation established accordingly has high accuracy in evaluating the poor prognosis of patients.