51例晚发型系统性红斑狼疮的临床特点及诊治要点分析

刘郑宇; 徐亮

doi:10.16766/j.cnki.issn.1674-4152.003100

51例晚发型系统性红斑狼疮的临床特点及诊治要点分析

doi: 10.16766/j.cnki.issn.1674-4152.003100

刘郑宇,
徐亮^,

皖南医学院第一附属医院(弋矶山医院)风湿免疫科, 安徽芜湖 241001

基金项目:

国家自然科学基金项目 30571740

详细信息

通讯作者:
徐亮，E-mail: xuliang_6657@163.com

中图分类号: R593.241
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出版历程
- 收稿日期: 2023-05-18

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

LIU Zhengyu,
XU Liang^,

Department of Rheumatology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China

摘要

摘要: 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。
- 系统性红斑狼疮 /
- 晚发型 /
- 临床特征 /
- 治疗
Abstract: 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.
- Systemic lupus erythematosus /
- Late-onset /
- Clinical features /
- Treatment
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表 1 2组SLE患者一般资料比较

Table 1. Comparison of general data of SLE patients in 2 groups

组别	例数	性别[例(%)]		诊断年龄(x±s，岁)	病程[M(P₂₅, P₇₅), 月]	共病[例(%)]
组别	例数	男性	女性	诊断年龄(x±s，岁)	病程[M(P₂₅, P₇₅), 月]	共病[例(%)]
ASLE组	119	8(6.7)	111(93.3)	33±8	1.0(0.5，5.0)	29(24.3)
LSLE组	51	5(9.8)	46(90.2)	59±7	3.0(1.0，12.0)	38(74.5)
统计量		0.143^a		19.285^b	-3.391^c	37.586^a
P值		0.706		＜0.001	0.001	＜0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组SLE患者临床症状比较[例(%)]

Table 2. Comparison of clinical symptoms of SLE patients in 2 groups[cases(%)]

组别	例数	关节炎	浆膜炎	雷诺现象	发热	乏力	皮疹	口腔溃疡	体重下降	脱发	光过敏	肺动脉高压	肺间质病变	肾脏病变	干燥综合征表现
ASLE组	119	41(34.4)	34(28.5)	9(7.6)	37(31.1)	14(11.7)	75(63.0)	2(1.7)	8(6.7)	24(20.1)	34(28.5)	6(5.0)	10(8.4)	28(23.5)	5(4.2)
LSLE组	51	22(43.1)	21(41.2)	4(7.8)	8(15.7)	8(15.7)	17(33.3)	3(5.9)	5(9.8)	9(17.6)	2(3.9)	2(3.9)	8(15.7)	8(15.7)	12(23.5)
χ²值		1.154	2.592	0.004	4.353	0.487	12.675	2.208	0.480	0.145	12.995	0.100	2.000	1.316	14.818
P值		0.283	0.107	0.950	0.037	0.485	＜0.001	0.137	0.488	0.703	＜0.001	0.752	0.157	0.251	＜0.001

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表 3 2组SLE患者实验室指标比较

Table 3. Comparison of laboratory indexes of SLE patients in 2 groups

组别	例数	白细胞计数(x±s，×10⁹/L)	淋巴细胞计数(x±s，×10⁹/L)	血红蛋白浓度(x±s，g/L)	血小板计数(x±s，×10⁹/L)	红细胞沉降率(x±s，mm/h)	C-反应蛋白[M(P₂₅, P₇₅)，mg/L]	补体C3 [M(P₂₅, P₇₅)，g/L]	低补体血症[例(%)]	免疫球蛋白(x±s，g/L)	24小时尿蛋白[M(P₂₅, P₇₅)，g/24 h]
ASLE组	119	4.33±2.17	1.05±0.56	100.81±22.33	150.87±74.36	51.09±29.28	4.32(2.44，10.94)	0.495(0.350, 0.680)	99(83.2)	19.58±5.14	0.070(0.020，0.375)
LSLE组	51	3.43±1.70	0.91±0.49	101.29±18.11	133.10±70.03	52.04±30.81	4.40(2.93，14.99)	0.575(0.405, 0.833)	34(66.7)	18.85±4.53	0.100(0.040，0.250)
统计量		2.453^a	1.454^a	-0.138^a	1.453^a	-0.191^a	-0.805^b	-2.052^b	5.726^c	0.831^a	-0.575^b
P值		0.010	0.150	0.890	0.150	0.610	0.421	0.040	0.017	0.407	0.565
注：^a为t值，^b为Z值，^c为χ²值。

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表 4 2组SLE患者自身抗体比较[例(%)]

Table 4. Comparison of autoantibodies between 2 groups of SLE patients[cases(%)]

组别	例数	抗ds-DNA抗体	抗核小体抗体	抗组蛋白抗体	抗Sm抗体	抗核糖体P蛋白抗体	抗SSA-60KD抗体	抗SSA-52KD抗体	抗U1-RNP抗体	抗线粒体抗体	抗人球蛋白试验
ASLE组	119	94(79.0)	23(35.3)	29(44.6)	66(55.5)	22(33.8)	78(65.5)	66(55.5)	39(34.2)	9(13.8)	11(26.2)
LSLE组	51	32(62.7)	9(34.6)	10(38.4)	19(37.2)	4(18.1)	29(56.9)	24(47.1)	15(30.0)	4(15.3)	1(9.1)
χ²值		4.912	0.005	0.287	4.734	3.102	1.154	1.102	0.279	0.036	1.455
P值		0.027	0.945	0.592	0.030	0.078	0.283	0.314	0.666	0.850	0.228
注：每组阳性百分比为阳性例数/阳性和阴性总例数。

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表 5 2组SLE患者疾病活动比较[M(P₂₅, P₇₅)，分]

Table 5. Comparison of disease activity in SLE patients in 2 groups[M(P₂₅, P₇₅), points]

组别	例数	SLEDAI-2000	BILAG-2004
ASLE组	119	10(8，14)	32(24，44)
LSLE组	51	9(6，13)	24(16，36)
Z值		-2.168	-3.898
P值		0.030	＜0.001

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表 6 2组SLE患者糖皮质激素使用比较

Table 6. Comparison of glucocorticoid use in 2 groups of SLE patients

组别	例数	糖皮质激素[例(%)]	糖皮质激素使用剂量[M(P₂₅, P₇₅), mg/d]	糖皮质激素使用比例[M(P₂₅, P₇₅), mg/(kg·d)]	冲击治疗[例(%)]	大剂量[例(%)]	中等剂量[例(%)]	小剂量[例(%)]
ASLE组	119	118(99.2)	50.0(37.5，100.0)	1.00(0.83，2.00)	17(14.3)	36(30.2)	52(43.7)	14(11.8)
LSLE组	51	50(98.0)	50.0(25.0，50.0)	0.88(0.50，1.25)	3(5.9)	6(11.8)	28(54.9)	14(27.5)
统计量		0.385^a	-3.432^b	-2.899^b	2.429^a	6.559^a	1.799^a	6.385^a
P值		0.535	0.001	0.004	0.119	0.010	0.180	0.012
注：^a为χ²值，^b为Z值。

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表 7 2组SLE患者免疫抑制剂合计使用比较

Table 7. Comparison of total immunosuppressant use in SLE patients in 2 groups

组别	例数	免疫抑制剂[例(%)]	免疫抑制剂使用种类[M(P₂₅, P₇₅)，种]
ASLE组	119	104(87.4)	1(1，2)
LSLE组	51	35(68.6)	1(0，1)
统计量		8.433^a	-3.383^b
P值		0.004	0.001
注：^a为χ²值，^b为Z值。

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表 8 2组SLE患者免疫抑制剂及羟氯喹使用比较[例(%)]

Table 8. Comparison of immunosuppressive and hydroxychloroquine use in SLE patients in 2 groups[cases(%)]

组别	例数	霉酚酸酯	环磷酰胺	甲氨蝶呤	环孢素A	硫唑嘌呤	来氟米特	羟氯喹
ASLE组	119	61(51.3)	56(47.0)	27(22.7)	3(2.5)	4(3.4)	7(5.9)	118(99.1)
LSLE组	51	16(31.4)	11(21.6)	4(7.8)	4(7.8)	1(1.9)	4(7.8)	49(96.1)
χ²值		5.699	9.714	5.277	2.561	0.245	0.277	1.955
P值		0.017	0.002	0.022	0.110	0.620	0.634	0.162

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