Ståhl-Hallengren C, Jönsen A, Nived O, Sturfelt G
Department of Rheumatology, Lund University Hospital, Sweden.
J Rheumatol. 2000 Mar;27(3):685-91.
To identify all new cases of systemic lupus erythematosus (SLE) within a defined area in Southern Sweden with validated methods of retrieval, and to compare 2 cohorts assembled during 1981-86 and 1987-91.
The catchment area, the health care district of Lund-Orup, had during 1981-91 a mean adult population (> 15 years of age) of 172,300 individuals. During 1987-91 we identified 379 individuals with potential SLE diagnosis from diagnosis registers and from central laboratory databases. Out of these, 121 had a previously known SLE diagnosis. All patient records were reviewed and patients with possible SLE not already known at the SLE unit were invited and examined. Organ damage was recorded as the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index.
Forty-one new SLE cases were diagnosed during 1987-91, giving a median annual incidence of 4.8/100,000 inhabitants, with a median age at diagnosis of 47 years. The incidence is similar to that found 1981-86 (4.5/100,000/year) in the same population using the same methods for retrieval. Age and sex-specific incidence 1981-91 was notably highest at the age of 65-74 (14.1/100,000/year) in women and age 65-74 (3.2/100,000/year) in men. The point prevalence on December 31, 1986, was a 42/100,000 and on December 31, 1991, 68/100,000. The 5 year survival was 93% and 10 year survival 83%. While overall survival was not decreased, 10 year survival was slightly reduced compared with an age and sex matched healthy population (p = 0.03). In the 1987-91 cohort the sensitivity of the American Rheumatism Association criteria was 92.7% and the specificity was 94%. The frequency of renal manifestations was decreased in the latter cohort. The damage rate was highest during the first year and then constant during a 5 year followup, and was similar in the 2 cohorts. Damage that related to atherosclerosis was common and cardiovascular disease was the most common cause of death.
The incidence of SLE in Sweden was notably constant during the 11 years 1981-91. Mortality was low and only late mortality (> 10 years disease duration) exceeded that in an age and sex matched control population. Atherosclerosis was the main cause of damage and mortality. Specificity and sensitivity of the ACR classification criteria are high in this epidemiologically recruited cohort.
采用经过验证的检索方法，识别瑞典南部特定区域内系统性红斑狼疮（SLE）的所有新发病例，并比较1981 - 1986年和1987 - 1991年期间组建的两个队列。
研究区域为隆德 - 奥鲁普医疗保健区，在1981 - 1991年期间，成年人口（>15岁）平均为172,300人。在1987 - 1991年期间，我们从诊断登记册和中央实验室数据库中识别出379例可能患有SLE的个体。其中，121例之前已确诊为SLE。对所有患者记录进行了审查，并邀请并检查了SLE科室尚不了解的可能患有SLE的患者。器官损伤记录为系统性红斑狼疮国际协作临床研究组/美国风湿病学会（SLICC/ACR）损伤指数。
1987 - 1991年期间确诊了41例新的SLE病例，年发病率中位数为4.8/100,000居民，诊断时年龄中位数为47岁。该发病率与1981 - 1986年期间在同一人群中使用相同检索方法得出的发病率（4.5/100,000/年）相似。1981 - 1991年按年龄和性别划分的发病率在65 - 74岁女性中最高（14.1/100,000/年），在65 - 74岁男性中为3.2/100,000/年。1986年12月31日的点患病率为42/100,000，1991年12月31日为68/100,000。5年生存率为93%，10年生存率为83%。虽然总体生存率没有降低，但与年龄和性别匹配的健康人群相比，10年生存率略有降低（p = 0.03）。在1987 - 1991年队列中，美国风湿病协会标准的敏感性为92.7%，特异性为94%。后一个队列中肾脏表现的频率有所下降。损伤率在第一年最高，随后在5年随访期间保持稳定，两个队列相似。与动脉粥样硬化相关的损伤很常见，心血管疾病是最常见的死亡原因。
1981 - 1991年的11年间，瑞典SLE的发病率显著稳定。死亡率较低，只有晚期死亡率（疾病持续时间>10年）超过了年龄和性别匹配的对照人群。动脉粥样硬化是损伤和死亡的主要原因。在这个流行病学招募的队列中，ACR分类标准的特异性和敏感性较高。
