晚发性系统性红斑狼疮15年生存率及预后因素分析

Analysis of the 15-year survival rate and its prognostic factors in late-onset systemic lupus erythematosus

目的回顾性分析晚发性系统性红斑狼疮(SLE)患者15年生存率、死亡原因和预后因素。方法系统性回顾收集2006年1月至2016年12月在新疆维吾尔自治区人民医院风湿免疫科住院的92例晚发性SLE(发病年龄>50岁)患者的临床及血清学资料,并进行门诊或电话随访,所有患者均符合1997年美国风湿病学会修订的SLE分类标准,分析其生存率、死亡原因及预后相关因素。结果92例患者中失访8例(8.7%8/92),随访84例(91.3%84/92)中64例(76.2%64/84)生存,20例(23.8%20/84)死亡,中位生存期108个月,晚发性SLE患者5年、10年和15年的累积生存率分别为:86.0%、77.9%和59.6%。感染(55.0%)和多脏器衰竭(15.0%)是其主要死亡原因。晚发性SLE患者预后单因素分析显示发病年龄(HR=1.113,P=0.001)、血液系统受累(HR=3.610,P=0.023)、合并心血管疾病(HR=3.128,P=0.011)对预后有显著影响。结论晚发性SLE的生存率及预后仍较差,预防感染及控制脏器损伤,关注合并的心血管疾病,对提高晚发性SLE的生存率有重要意义。

Objective To analyze the 15-year survival rate,causes of death and prognostic factors of late-onset systemic lupus erythematosus(SLE).Methods A total of 92 late-onset SLE patients aged>50 years hospitalized in the Rheumatology and Immunology Department of the People's Hospital of Xinjiang Autonomous Region from January 2006 to December 2016 were retrospectively collected.Clinical and serological data of the patients were analyzed and the diagnosis met the SLE classification criteria as revised by the American Society of Rheumatology in 1997.Survival rate,the cause of death,and the associated prognostic factors were analyzed.Outpatient or telephone follow-up was performed.Results Of the 92 study patients,8 were lost to follow-up(8/92,8.7%)and 84 were able to follow up(84/92,91.3%).Of the 84 able to follow up,64 cases(64/84,76.2%)survived,and 20 cases(20/84,23.8%)died.Median survival time was 108 months.The 5-,10-,and15-year survival rates were 86.0%,77.9%and 59.6%,respectively.Infection(55.0%)and multiple organ failure(15.0%)were the major cause of death in patients with late-onset SLE.Univariate analysis of the outcomes of patients with late-onset SLE showed that the age of onset(HR=1.113,P=0.001),hematology involvement(HR=3.610,P=0.023),and complicaed cardiovascular disease(HR=3.128,P=0.011)had a significant impact on the prognosis.Conclusions The late-onset SLE has low survival rate and bad prognosis.Infection prevention and control of organ damage and focus on merging cardiovascular disease are critical to improve survival of late-onset SLE patients.