重症神经精神性狼疮治疗决策的分析

Analysis of decision of therapies for severe neuropsychiatric lupus

目的 分析激素和环磷酰胺的治疗对重症神经精神性狼疮 (NPLE)预后的影响 ,探讨重症NPLE的临床治疗。方法 回顾性分析 168例重症NPLE ,激素和环磷酰胺治疗对结局的影响。运用单因素的Logistic分层回归 ,分析激素和环磷酰胺各种用法对死亡的影响。再对 5 3个临床和实验室指标进行单因素分析 ,然后建立Logistic回归模型。结果 168例NPLE患者中 3 9例死亡 ,占 2 3 2 %。单因素的Logistic回归分层分析显示 ,与口服泼尼松比较 ,静脉注射地塞米松不能降低重症NPLE的病死率 ;甲基泼尼松龙冲击治疗和各种环磷酰胺疗法的OR值均 <1,且 95 %CI值均未包含1,提示有统计学意义。Logistic多元回归模型显示 ,甲基泼尼松龙冲击治疗 (OR =0 2 4,95 %CI =0 10～ 0 61)和环磷酰胺冲击治疗 (剂量≤ 1g :OR =0 3 0 ,95 %CI=0 13～ 0 73 ;剂量 >1g :OR =0 2 1,95 %CI =0 0 8～ 0 5 3 )可降低重症NPLE的病死率。结论 在重症NPLE的治疗中 ,环磷酰胺和 (或 )甲基泼尼松龙冲击治疗可以减少死亡 ,改善预后。

Objective To study the treatment of severe neuropsychiatric lupus(NPLE) by analysis of therapies with corticosteroid and cyclophosphamide.Methods A retrospective cohort study was employed. 168 patients diagnosed as severe NPLE from 1991 to 2001 in the university hospital were included in the study. The data were analyzed using logistic regression model. Results In the univariate analysis, pulse methylprednisolone therapy but not intravenous dexamethasone was significantly associated with reduction of mortality comparing to oral prednisone( OR =0 29, 95% CI=0 12～0 71). Cyclophosphamide therapies also reduced the mortality in univariate analysis. In logistic regression model, only pulse methylprednisolone( OR =0 24, 95% CI=0 10～0 61) and pulse cyclophosphamide( OR =0 30, 95% CI=0 13～0 73 in low dose and OR =0 21, 95% CI=0 08～0 53 in high dose) therapies were significantly associated with reduction of death. Conclusion Pulse methylprednisolone and pulse cyclophosphamide are effective therapies in reducing mortality of severe NPLE.