两种评估重症狼疮方法比较及重症相关因素与预后分析

发布时间：2018-06-08 21:33

本文选题：重症狼疮 + BILAG-2004　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过回顾性分析系统性红斑狼疮住院患者临床资料,评估两种评分标准对重症狼疮(Severe Systemic Lupus Erythematosus,SSLE)的诊断识别情况,并对SSLE发生的相关因素进行分析,同时探讨SSLE的预后,从而为早期识别SSLE,预防轻、中型SLE转变为SSLE,改善患者预后提供依据。方法:对2006年12月1日到2016年12月1日入住大连医科大学附属大连市中心医院198例SLE住院患者的临床资料进行回顾性分析。分析包括两部分:一:采用SLEDAI、BILAG评分标准识别SSLE,依据2010年中华风湿病学会狼疮分型标准:SLEDAI积分≥15分为SSLE,BILAG评分中,任一系统达A级或至少三个系统均达B级为SSLE。符合标准之一即纳入SSLE,两标准均未达到者计入非SSLE。比较两组数据的差异,评价两者的敏感性及实用性。二:采用病例对照研究方法探讨SSLE发生的相关因素。通过上述两种标准,将SSLE患者病例组与非SSLE患者对照组进行比较。收集病例的临床资料包括性别、民族、职业、常住地、家族史、妊娠史、临床表现、疾病活动相关辅助化验检查结果、治疗方案及结局转归、住院费用等,采用多因素Logistic回归分析SSLE发生的相关危险因素。结果:1.本研究医院10年间SLE住院患者累计198例,共628次住院。通过BILAG-2004评分,符合重症标准共127例,138次重症发作住院;通过SLEDAI-2000评分符合重症标准共71例,78次重症发作住院;同时符合上述两评分系统的SSLE患者共68例,75次重症发作住院;2.符合上述两评分系统的SSLE共130例(141次重症发作住院),占SLE患者总住院次数22.5%(141/628)。其中不符合BILAG-2004评估SSLE诊断标准3例,共3次重症发作住院,但其已达到BILAG-2004评分系统中度标准,且3例都累及5个系统,对应的SLEDAI-2000评分均≥15分,其评分分别为16分、15分、27分。此130例SSLE不符合SLEDAI-2000SSLE诊断标准59例,共63次重症发作住院;这59例患者SLEDAI-2000中位评分值为8分,但BILAG-2004评分均达SSLE水平,其中33次累及血液系统达A类,15次累及呼吸循环系统达A类,11次累及肾脏达A类,5次累及消化系统达A类,4次累及3个以上系统达B类;3.SSLE组首次发病以皮肤粘膜系统69例(53.1%)、肌肉骨骼系统47例(36.2%)、一般非特异症状系统39例(30%)、泌尿系统28例(21.5%)、血液系统27例(20.8%)、呼吸循环系统5例(3.8%)、消化系统2例(1.5%)、神经系统2例(1.5%)、眼部系统未累及(0%);非SSLE组首次发病以皮肤粘膜损害系统47例(69.1%),肌肉骨骼系统44例(64.7%)、一般非特异症状系统23例(33.8%)、泌尿系统12例(17.6%)、血液系统10例(14.7%)、消化系统2例(2.9%),未有首次以神经系统、呼吸循环系统、眼部系统受累者,上述系统两组间比较差异均有统计学意义(P0.05);SSLE主要累及器官包括血液系统120例(85.1%)、泌尿系统95例(67.4%)、皮肤粘膜系统69例(48.9%)、一般非特异症状系统62例(44.0%)、呼吸循环系统53例(37.5%)、神经系统32例(22.7%)、消化系统26例(18.4%)、眼部系统1例(0.7%),非SSLE组血液系统36例(52.9%)、泌尿系统20例(29.4%)、皮肤粘膜系统48例(70.6%)、肌肉骨骼系统46例(67.6%),一般非特异症状系统有21例(30.9%)、消化系统4例(5.9%)、呼吸循环系统3例(4.4%)、眼部系统1例(1.5%),未有神经系统累及,其中一般非特异症状系统、眼部系统比较差异无统计学意义(P0.05),余系统组间比较差异有统计学意义(P0.05);4.本组病例男性27例,女性171例,男女比为1:6.3,SSLE组中,男性21例,女性109例,男女比为1:5.2;非SSLE组,男性6例,女性62例,男女比为1:10.3,两组间比较差异无统计学意义(P=0.1540.05);SSLE组常住地为大连城市(含城郊)有102例(78.5%),大连农村有28例(21.5%),非SSLE组常住地为大连城市(含城郊)有61例(89.7%),大连农村有7例(10.3%),SSLE组诊断年龄50岁有84例(64.6%)、诊断年龄≥50岁有46例(35.4%),非SSLE组诊断年龄50岁有54例(79.4%)、诊断年龄≥50岁有14例(20.6%),SSLE组无确切诱因102次(72.3%);有确切诱因者39次(27.7%),非SSLE组无确切诱因61次(89.8%),有确切诱因者7次(10.2%),SSLE组器官系统累及个数≤3个的有63例(48.5%),累及个数3个的有67例(51.5%),非SSLE组器官系统累及个数≤3个的有57例(83.8%),累及个数3个的有11例(16.2%),常住地、诊断年龄、诱因、器官系统累及个数组间比较其差异有统计学意义(P0.05);此外,民族、职业、发病年龄、住院年龄、结核感染史、家族史、女性妊娠流产史、病程等组间比较差异均无统计学意义(P0.05);5.SSLE组与非SSLE组化验指标分别比较,24h尿蛋白定量、BUN、SCR、TP、ALB、AST、CRP、ESR、C3、C4、IgA、ANA 滴度、抗 SSB 抗体组间比较差异有统计学意义(P0.05),而ALT、TB、DB、IgG、IgM、抗dsDNA抗体以及除抗SSB抗体的ENA谱的组间差异无统计学意义(P0.05);6.Logistic回归分析结果显示有无确切诱因、器官系统累及数是否≥3个、常住农村或城市、诊断年龄是否≥50岁、血沉快慢、ANA滴度情况、IgA水平、抗SSB抗体与SSLE的相关性有统计学意义(P0.05);7.SSLE组10年间住院患者共有10例死亡,病死率为7.7%(10/130),且以感染、多脏器衰竭为主要死亡原因,而非SSLE组未有死亡病例。结论:1.BILAG-2004评分、SLEDAI-2000评分结果显示前者敏感性远高于后者,且与后者符合率高,不易漏诊,但前者评估参数较多,方法较为繁琐,因此首先推荐应用BILAG-2004评估SSLE,条件允许时也可联合采用SLEDAI-2000评分诊断 SSLE;2.SSLE以皮肤粘膜系统、肌肉骨骼系统为首发临床表现;其主要受累器官以血液系统、泌尿系统最常见,此点不同于非SSLE;有确切诱因、器官系统累及个数越多、常住农村、诊断年龄越大、血沉越快、中高滴度ANA、中高水平的IgA、抗SSB抗体阳性是发生、发展为SSLE的相关危险因素,与女性相比男性患者更易发展为SSLE;3.SSLE住院10年病死率为7.7%(10/130),感染、多脏器衰竭为主要死亡原因。
[Abstract]:Objective: To evaluate the clinical data of patients with systemic lupus erythematosus (SLE), evaluate the diagnosis and identification of Severe Systemic Lupus Erythematosus (SSLE) by two scoring criteria, analyze the related factors of SSLE, and discuss the prognosis of SSLE, so as to identify SSLE, prevent light and moderate SLE transition in early stage. The clinical data of 198 patients hospitalized in Dalian Central Hospital, Dalian Medical University, Dalian Medical University from December 1, 2006 to December 1, 2016 were analyzed retrospectively. The analysis included two parts: 1: using SLEDAI, BILAG standard to identify SSLE, according to the 2010 Chinese rheumatism society Wolf Sore typing standard: SLEDAI score more than 15 points SSLE, BILAG score, any system reached a Class A or at least three systems reached B level as one of the SSLE. conforms to SSLE, two standards were not reached in non SSLE. comparison two groups of data differences, evaluate the sensitivity and practicality of both. Two: case control study method to explore SSLE hair The related factors of birth were compared with those of the control group of the SSLE patients and the non SSLE patients. The clinical data of the cases included sex, nationality, occupation, permanent residence, family history, pregnancy history, clinical manifestation, auxiliary test results of disease activities, treatment scheme and outcome, hospitalization expenses, and so on. Factor Logistic regression analysis of the related risk factors of SSLE. Results: 1. the total number of hospitalized patients with SLE in the 10 years of this study was 198 cases, with a total of 628 hospitalized patients. Through the BILAG-2004 score, 127 cases were conformed to severe criteria and 138 severe attacks were hospitalized; 71 cases were conformed to the severe standard and 78 severe attacks were hospitalized by the SLEDAI-2000 score. A total of 68 SSLE patients and 75 severe episodes were hospitalized in the two scoring system; 2. were in line with the above two scoring system in 130 cases (141 severe episodes of hospitalization), accounting for 22.5% (141/628) of the total hospitalization of the SLE patients, which did not conform to the BILAG-2004 evaluation of the SSLE diagnostic criteria for 3 cases and were hospitalized for 3 severe episodes, but they had reached a moderate BILAG-2004 scoring system. Standard, and 3 cases were involved in 5 systems, the corresponding SLEDAI-2000 scores were more than 15 points, and their scores were 16, 15, 27. 130 cases of SSLE did not conform to the SLEDAI-2000SSLE diagnostic criteria for 59 cases and were hospitalized for 63 severe episodes; the median score of the 59 patients was 8, but the BILAG-2004 score was SSLE level, among which 33 involves the blood involvement of the blood. The system reached a Class A, 15 involvement of the respiratory circulation system as a Class A, 11 times involving the kidney a Class A, 5 times involving the digestive system to a Class A, 4 times involving more than 3 systems to B; the first onset of the 3.SSLE group was 69 cases of the skin and mucous membrane system (53.1%), the musculoskeletal system 47 cases (36.2%), the general non specific symptom system 39 cases (30%), the urinary system 28 cases (21.5%), blood system. 27 cases (20.8%), 5 cases (3.8%) of respiratory and circulation system, 2 cases of digestive system (1.5%), 2 cases of nervous system (1.5%), and no involvement of the eye system (0%). The first onset of non SSLE group was 47 cases (69.1%), 44 cases of musculoskeletal system (64.7%), non specific symptom system, urinary system, blood system. There were 2 cases (2.9%) of digestive system (2.9%). There was no significant difference between the two groups of the two groups (P0.05); SSLE mainly involved organs including blood system (85.1%), urinary system 95 (67.4%), skin and mucous membrane system 69 cases (48.9%), and general nonspecific symptom system 62 cases (4). 4%) respiratory and circulatory system (37.5%), nervous system 32 cases (22.7%), digestive system 26 cases (18.4%), eye system 1 cases (0.7%), non SSLE blood system 36 cases (52.9%), urinary system 20 cases (29.4%), musculoskeletal system, musculoskeletal system and digestive system. There were 3 cases (4.4%) of respiratory circulatory system and 1 cases (1.5%) of eye system. There was no nervous system involvement. There was no statistical difference in the general non specific symptom system (P0.05), and there was significant difference between the remaining system groups (P0.05); 4. cases were male 27, female 171, male and female were 1:6.3, SSLE group, 21 male, female male, female Sex ratio was 109 cases, male and female ratio was 1:5.2; non SSLE group, male 6 cases, female 62 cases, male and female ratio 1:10.3, two groups had no statistical difference (P=0.1540.05); SSLE group was Dalian city (including suburb) 102 cases (78.5%), Dalian rural 28 cases (21.5%), Dalian city (including suburb) of non SSLE group, 61 (89.7%), Dalian rural 7 10.3% (10.3%), 84 cases (64.6%) were diagnosed at the age of 50, 46 (35.4%) aged more than 50 years old, 54 (79.4%) at the age of 50 (79.4%) in the non SSLE group, and there were 14 cases (20.6%) in the diagnosis age more than 50 years, and there were no exact inducements in group SSLE. In group SSLE, there were 63 cases (48.5%) involved in the organ system of less than 3, 67 cases (51.5%) involving a number of 3, 57 (83.8%) involving a number of less than 3 in the non SSLE organ system, and 3 of 11 cases (16.2%) involving the number 3, the diagnosis age, the inducement, and the difference between the organs involved in an array (P0.05); moreover, besides, There was no significant difference between the nationalities, the occupations, the age of the onset, the age of hospitalization, the history of tuberculosis infection, the history of tuberculosis infection, the history of the family, the history of pregnancy abortion, and the course of the disease (P0.05), and the comparison of the 24h urine protein, BUN, SCR, TP, ALB, AST, CRP, and ESR, between the 5.SSLE and the non SSLE group. Learning significance (P0.05), while ALT, TB, DB, IgG, IgM, anti dsDNA antibody and the ENA spectrum of anti SSB antibody were not statistically significant (P0.05); 6.Logistic regression analysis showed whether there was an exact inducement, or whether the organ system was involved in more than 3, living in the countryside or City, whether the age was more than 50 years old, the blood sedimentation rate was slow, ANA titer, levels, The correlation between anti SSB antibody and SSLE was statistically significant (P0.05); there were 10 deaths in the 10 patients in group 7.SSLE and 7.7% (10/130), and the main cause of death was infection and multiple organ failure, but no death in group SSLE. Conclusion: 1.BILAG-2004 scores, SLEDAI-2000 score showed that the former was much more sensitive than the latter, And it is not easy to be diagnosed with the latter, but the former has more parameters and more complicated methods. Therefore, first of all, it is recommended to use BILAG-2004 to evaluate SSLE. When conditions permit, SLEDAI-2000 can also be used to diagnose SSLE; 2.SSLE is the first clinical manifestation of the skin and mucous membrane system and musculoskeletal system; the main involved organ is the blood system, Urinary system is the most common, which is different from non SSLE; there are definite causes, the more the organ system is involved, the more the organ system is involved, the greater the diagnosis age, the faster the blood sedimentation, the high titer ANA, the high level of IgA, the anti SSB antibody positive, the related risk factors of SSLE, and the more likely to develop to the SSLE for the male patients compared with the female; 3.SSLE is 10 years in hospital. The fatality rate was 7.7% (10/130), and infection and multiple organ failure were the main causes of death.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241

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