Borchers Andrea T, Keen Carl L, Shoenfeld Yehuda, Gershwin M Eric
Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, TB 192, One Shields Avenue, Davis, CA 95616, USA.
Autoimmun Rev. 2004 Aug;3(6):423-53. doi: 10.1016/j.autrev.2004.04.002.
To address changes in survival of patients with systemic lupus erythematosus (SLE) and to compare mortality statistics with associated disease specific as well as comorbid conditions.
Review of the international literature on survival of patients with SLE.
During the first half of the 20th century, SLE was considered a rapidly progressive and almost invariably fatal disease. Since the 1950s, the estimated 5-year survival of SLE patients in developed countries rose from <50% to >95% and similar increases were seen in 10-year survival. Mortality rates of SLE patients, however, remain approximately 3 times that of an age- and sex-matched population in most studies, indicating that death still occurs prematurely in a substantial portion of patients, albeit later in the disease course. This improved prognosis does not appear to have been shared equally by all racial/ethnic groups. This appears to be attributable more to socioeconomic and sociocultural factors than to true differences in disease manifestations. Along with the increased survival of SLE patients, there has been a change in the causes of death. Most notably, there has been a dramatic increase in the proportionate mortality from vascular disease, particularly accelerated atherosclerosis. Both disease and therapeutic modalities, in particular corticosteroids, appear to contribute to the high prevalence of coronary artery disease (CAD).
Much progress has been made in improving the survival of SLE, but there is need for further improvement. Aggressive treatment of risk factors for CAD is advisable, but it remains to be assessed to what extent such interventions can further reduce mortality.
探讨系统性红斑狼疮(SLE)患者生存率的变化,并将死亡率统计数据与相关疾病特异性及合并症情况进行比较。
回顾关于SLE患者生存率的国际文献。
在20世纪上半叶,SLE被认为是一种进展迅速且几乎必然致命的疾病。自20世纪50年代以来,发达国家SLE患者的估计5年生存率从<50%升至>95%,10年生存率也有类似增长。然而,在大多数研究中,SLE患者的死亡率仍约为年龄和性别匹配人群的3倍,这表明尽管在疾病后期死亡,但仍有相当一部分患者过早死亡。这种预后改善似乎并非所有种族/族裔群体均等享有。这似乎更多归因于社会经济和社会文化因素,而非疾病表现的真正差异。随着SLE患者生存率的提高,死亡原因也发生了变化。最显著的是,血管疾病导致的比例死亡率大幅上升,尤其是加速性动脉粥样硬化。疾病和治疗方式,特别是皮质类固醇,似乎都导致了冠状动脉疾病(CAD)的高患病率。
在提高SLE患者生存率方面已取得很大进展,但仍需进一步改善。对CAD危险因素进行积极治疗是可取的,但此类干预措施能在多大程度上进一步降低死亡率仍有待评估。