51例晚发型系统性红斑狼疮的临床特点及诊治要点分析

Analysis of clinical characteristics and diagnostic and treatment of 51 cases of late-onset systemic lupus erythematosus

目的对比晚发型系统性红斑狼疮(LSLE)与中青年型系统性红斑狼疮(ASLE)的流行病学、临床表现、实验室检查及治疗方案,探究LSLE的临床特征及诊治特点。方法收集2017年9月-2022年6月于皖南医学院第一附属医院初诊初治的170例系统性红斑狼疮(SLE)患者的病历资料并进行回顾性分析。以患者发病时年龄分为2组:≥50岁为LSLE组(51例);<50岁为ASLE组(119例)。结果与ASLE组比较,LSLE组发病至确诊时间显著延长[3.0(1.0,12.0)月vs.1.0(0.5,5.0)月,Z=-3.391,P=0.001],LSLE患者确诊时合并一种以上疾病比例显著增多;发热、皮疹及光过敏症状显著减少;合并干燥综合征占比显著增多;白细胞计数减少、低补体血症发生率显著降低,抗ds-DNA抗体、抗sm抗体阳性率显著降低;SLEDAI-2000及BILAG-2004评分显著减低。LSLE组完成疾病活动评估后糖皮质激素最大平均使用剂量及糖皮质激素使用比率显著降低;免疫抑制剂使用率、使用免疫抑制剂种类显著降低,霉酚酸酯、环磷酰胺、甲氨蝶呤使用率显著减少,以上差异均有统计学意义(均P<0.05)。结论相比于ASLE,LSLE患者典型SLE临床表现较少,起病至确诊时间长,病情相对较轻,治疗使用糖皮质激素剂量低及免疫抑制剂种类较少。

Objective To compare the epidemiology,clinical manifestations,laboratory tests,and treatment protocols of late-onset systemic lupus erythematosus(LSLE)and adult onset systemic lupus erythematosus(ASLE),and to explore the clinical features and diagnostic and therapeutic characteristics of LSLE.Methods The medical records of 170 patients with systemic lupus erythematosus(SLE)who were initially diagnosed and treated in the First Affiliated Hospital of Wannan Medical College from September 2017 to June 2022 were retrospectively analyzed.According to the age of onset,patients were divided into two groups:≥50 years old was the LSLE group(51 cases);<50 years old was in the ASLE group(119 cases).Results Compared with the ASLE group,the time from onset to diagnosis was significantly longer in the LSLE group[3.0(1.0,12.0)months vs.1.0(0.5,5.0)months,Z=-3.391,P=0.001],there was a significant increase in the percentage of patients with more than one disease at the time of diagnosis,a significant decrease in fever,rash,and photosensitivity,a significant increase in the percentage of patients with dry syndrome,a significant decrease in the incidence of leukopenia and hypocomplementemia,a significant decrease in the incidence of positive anti-d-DNA and anti-sm antibodies,and a significant decrease in the SLEDAI-2000 and BILAG-2004 scores.After the LSLE group completed the disease activity assessment,the maximum average dose of glucocorticoids and the rate of glucocorticoid use were significantly reduced.The use rate of immunosuppressants and the types of immunosuppressants used were significantly reduced,and the use of mycophenolate mofetil,cyclophosphamide and methotrexate was significantly reduced.The above differences were statistically significant(all P<0.05).Conclusion Compared with ASLE,patients with LSLE have fewer typical SLE clinical manifestations,a long time from onset to diagnosis,relatively mild disease,low dose of glucocorticoids and fewer types of immunosuppressants.