天疱疮患者生存分析

发布时间：2018-06-17 02:38

本文选题：天疱疮 + 预后　；参考：《广西医科大学》2010年硕士论文

【摘要】： 目的:了解本地区天疱疮患者的长期生存率,评估各相关参数与病人预后的关系,探索影响天疱疮患者长期存活的相关因素,为今后制定合理的治疗方案,提高疗效,降低死亡率提供参考依据。方法:采用回顾性分析方法,选择广西医科大学一附院2001年1月1日到2008年12月30日期间首次住院确诊的113例资料完整的天疱疮患者,查阅其病历资料,并通过电话咨询的方式对患者或家属进行调查,获得的随访资料用Microsoft Acess软件建立个人资料库。以天疱疮患者确诊日期作为观察起点,至患者死亡、失访或最近一次随访时间为随访终点。截尾数据确定标准:1,观察期满仍存活;2,失访;3,死亡原因不是由于天疱疮。整个随访工作于2010年2月4日终止。研究因素为临床表现,相关实验室结果,治疗及预后,死亡原因等。采用SPSS13.0统计学软件包进行生存分析,采用方差分析和X2检验对资料进行描述性分析。生存曲线比较采用Kaplan-Meier法,Cox单因素分析及Cox多因素分析,对相关因素先用单因素Cox比例风险模型进行分析,筛选出有统计学意义的因素再用多因素Cox比例风险模型进行分析,P0.05为有统计学意义。结果: 1.疾病状况: 1.1一般情况:由于资料和患者搬迁等原因造成失访者为23例,9年失访率为20.2%。本组患者男女比例为1.02:1,发病年龄在11～79岁,平均年龄为46.12岁,50%患者年龄为40～60岁。天疱疮所有类型中寻常型最常见(占82%);寻常型天疱疮男女发病率基本相等,落叶型天疱疮男性多于女性,疱疹样天疱疮女性多发。以口腔粘膜为首发部位的最多见,其次为躯干和头面,首发部位为四肢者最少见。寻常型天疱疮皮疹面积较其他类型天疱疮大,粘膜损害者比例高,红斑较少,P均0.05。 1.2实验室检查:寻常型天疱疮PLT升高较其他两型天疱疮明显,寻常型天疱疮与落叶型天疱疮ALT升高及ALB下降较疱疹样天疱疮明显,落叶型天疱疮和疱疹样天疱疮患者UA升高较寻常型天疱疮明显,P均0.05。 1.3治疗:寻常型天疱疮和落叶型天疱疮住院期间最大激素量较疱疹样天疱疮大,寻常型天疱疮和落叶型天疱疮患者病情较重,控制病情需要的激素量较疱疹样天疱疮多,P均0.05。 2. 113例天疱疮患者生存率在前15个月时下降比较明显,在15个月以后曲线下降较缓慢。 3.影响天疱疮患者预后的单因素分析中,作用有统计学意义(P0.05)的变量为年龄,粘膜损害,感染,WBC、RBC、DBIL、ALT、AST结果,单独使用激素,IgA结果。 4.多因素分析中,可能影响天疱疮患者预后的指标为ALT结果、RBC结果、单用激素治疗、粘膜损害、年龄、感染等,其回归系数均0,Exp(B)即危险因素值均1,ALT升高、RBC减少、单用激素治疗、合并粘膜损害、年龄大于60岁、有感染的患者预后不佳。 5.根据多因素分析的结果,拟合天疱疮患者的生存模型为h(tx)=h0(t)exp(1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6);推导出预后指数PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6)。 PI值越小,预后越好;PI值越大,预后越差。将2006年首次诊断天疱疮患者的资料代入以上公式,并计算其PI值,结果显示死亡的患者PI值较存活的患者大,P0.05。结论: 1.寻常型天疱疮和落叶型天疱疮患者病情较重,控制病情需要的激素量较疱疹样天疱疮大。 2.不同类型天疱疮存在部分实验室改变的差异:寻常型天疱疮PLT升高较其他两型天疱疮明显,寻常型天疱疮与落叶型天疱疮ALT升高及ALB下降较疱疹样天疱疮明显,落叶型天疱疮和疱疹样天疱疮患者UA升高较寻常型天疱疮明显。 3.天疱疮确诊后的前15个月内死亡率较其他时段高。 4.ALT升高、RBC降低、单用激素、合并粘膜损害、年龄大、合并感染为影响天疱疮患者生存率的独立因素。存在这些因素的患者预后不好。 5.根据多因素分析的结果,拟合本地区天疱疮患者的生存模型为hi(t)=h0(t)exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) 由此导出的预后指数PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6)可以作为临床有效预测天疱疮预后的工具。
[Abstract]:Objective: to understand the long-term survival rate of pemphigus patients in the region, evaluate the relationship between the parameters of pemphigus and the prognosis of patients, explore the related factors that affect the long-term survival of pemphigus, and provide a reference for the formulation of reasonable treatment scheme, the improvement of the curative effect and the reduction of mortality.
Methods: 113 cases of pemphigus diagnosed in the first hospital of Guangxi Medical University from January 1, 2001 to December 30, 2008 were selected by retrospective analysis. The patient's medical records were consulted and the patients or family members were investigated by telephone consultation. The follow-up data were built by Microsoft Acess software. Set up a personal database. The date of the diagnosis of pemphigus as the starting point, to the patient's death, the loss of visits, or the last time of follow-up was the end point. The truncated data determined the standard: 1, the observation period was still alive; 2, the loss of visits, and 3, the cause of death was not due to pemphigus. The whole follow-up was terminated in February 4, 2010. The factors of the study were clinical, The results of the related laboratory, treatment and prognosis, the cause of death, etc. were analyzed by SPSS13.0 software package. The data were analyzed by variance analysis and X2 test. The survival curve was compared with Kaplan-Meier, Cox single factor analysis and Cox multifactor analysis, and the related factors were first used for the single factor Cox proportional risk model. The statistical analysis was carried out to screen out statistically significant factors and then analyzed by multivariate Cox proportional hazards model. P0.05 was statistically significant.
Result:
1. condition of disease:
1.1 general situation: 23 cases were lost because of data and patients' relocation, and the rate of loss of visits in 9 years was 1.02:1, the age of onset was 11~79 years, the average age was 46.12, the age of 50% patients was 40~60 years old. The most common (82%) of all types of pemphigus (pemphigus vulgaris), the incidence of male and female pemphigus vulgaris, was the basis of the incidence of pemphigus vulgaris. The same, deciduous pemphigus male more than women, herpes like pemphigus more women. The most common in the first part of the oral mucosa, the second is the trunk and the head, the first part of the extremities is the most rare. The area of pemphigus vulgaris is larger than other types of pemphigus, the proportion of mucous membrane damage is high, the erythema is less, P 0.05.
1.2 laboratory examination: the increase of PLT in pemphigus vulgaris was significantly higher than that of other type two pemphigus. The increase of ALT in pemphigus vulgaris and deciduous pemphigus and the decrease of ALB were more obvious than herpes like pemphigus. The elevation of UA in patients with deciduous pemphigus and herpes like pemphigus was more obvious than that of pemphigus vulgaris, P 0.05.
1.3 treatment: the largest amount of hormone in patients with pemphigus vulgaris and deciduous pemphigus was larger than herpes like pemphigus, and patients with pemphigus vulgaris and deciduous pemphigus were more serious. The amount of hormone needed to control the disease was more than that of herpes like pemphigus, and P was 0.05.
The survival rate of 2.113 patients with pemphigus decreased significantly in the first 15 months, and decreased slowly after 15 months.
3. in a single factor analysis of the prognosis of pemphigus patients, the variables of statistical significance (P0.05) were age, mucous membrane damage, infection, WBC, RBC, DBIL, ALT, AST results, and the use of hormone and IgA results alone.
In the 4. multivariate analysis, the prognostic indicators of pemphigus patients were ALT results, RBC results, single hormone therapy, mucosal lesion, age, infection, and so on. The regression coefficient was 0, Exp (B) was 1 of the risk factors, ALT increased, RBC decreased, the single use of hormone treatment, mucous membrane damage, age more than 60 years, and the poor prognosis of the infected patients.
5. according to the results of multifactor analysis, the survival model of pemphigus was fitted to h (TX) =h0 (T) exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) and prognostic index PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6).
The smaller the PI value, the better the prognosis; the greater the PI value, the worse the prognosis. The data of the first diagnosis of pemphigus in 2006 were replaced by the above formula, and the PI value was calculated. The results showed that the PI value of the dead patients was larger than that of the surviving patients, P0.05.
Conclusion:
1. patients with pemphigus vulgaris and pemphigus vulgaris are more severe. The amount of hormone required to control the disease is larger than that of herpes like pemphigus.
2. different types of pemphigus in different types of pemphigus showed that the elevation of PLT in pemphigus vulgaris was significantly higher than that of other type two pemphigus, and that of pemphigus vulgaris with pemphigus vulgaris and deciduous pemphigus was significantly higher than that of herpes like pemphigus, and the increase of UA in deciduous pemphigus and herpes like pemphigus was significantly higher than that of pemphigus vulgaris in patients with defoliate pemphigus and herpes like pemphigus.
The mortality in the first 15 months after 3. days of diagnosis was higher than that in other periods.
4.ALT increased, RBC decreased, single use of hormones, mucous membrane damage, age, and infection were independent factors affecting the survival rate of pemphigus. These factors were not good for patients.
5. according to the results of multivariate analysis, the survival model of patients with pemphigus in this area is hi (T) =h0 (T) exp (1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6).
The derived prognostic index PI=1.508X1+2.162X2+1.338X3+0.671X4+1.956X5+1.325X6) can be used as a tool for predicting the prognosis of pemphigus clinically.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.66

【参考文献】