Bertoli A M, Vila L M, Apte M, Fessler B J, Bastian H M, Reveille J D, Alarcon G S
Department of Medicine (Division of Rheumatology), The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
Lupus. 2007;16(6):410-7. doi: 10.1177/0961203307079042.
The objective of this study was to determine the factors predictive of time to the occurrence of pulmonary damage in systemic lupus erythematosus (SLE). Six-hundred and twenty-six SLE patients from a multiethnic (Hispanics, African Americans and Caucasians) longitudinal study of outcome were studied. Pulmonary damage was defined as per the Systemic Lupus International Collaborating Clinics Damage Index. Socioeconomic-demographic, clinical, genetic, serological features, pharmacologic treatments, behavioural, psychological and disease activity [as per the Systemic Lupus Activity Measure-Revised (SLAM-R)] were examined. Factors associated with time to the occurrence of pulmonary damage were examined by Cox proportional hazards regressions. A Kaplan-Meier survival curve was also examined. Forty-six (7.3%) patients had pulmonary damage after a mean (SD) total disease duration of 5.3 (3.6) years. Among those patients, 25 had pulmonary fibrosis, 12 pulmonary hypertension, eight pleural fibrosis, four pulmonary infarction and four shrinking lung syndrome. Seven patients had more than one type of lung damage. Cumulative rates of pulmonary damage at five and 10 years were 7.6% and 11.6%, respectively. In the multivariable analyses, age (HR = 1.033, 95% CI 1.006-1.060; P = 0.0170), pneumonitis (HR = 2.307, 95% CI 1.123-4.739; P = 0.0229) and anti-RNP antibodies (HR = 2.344, 95% CI 1.190-4.618; P = 0.0138) were associated with a shorter time to the occurrence of pulmonary damage while photosensitivity (HR = 0.388, 95% CI 0.184-0.818; P = 0.0128) and oral ulcers (HR = 0.466, 95% CI 0.230-0.942; P = 0.0335) with a longer time. Pulmonary damage is relatively common in SLE. Age, pneumonitis and anti-RNP antibodies were associated with a shorter time to the development of permanent lung disease.
本研究的目的是确定系统性红斑狼疮（SLE）患者发生肺部损害时间的预测因素。对来自一项多民族（西班牙裔、非裔美国人和白种人）纵向结局研究的626例SLE患者进行了研究。肺部损害根据系统性红斑狼疮国际协作临床损害指数进行定义。研究了社会经济人口学、临床、遗传、血清学特征、药物治疗、行为、心理和疾病活动情况[根据修订的系统性狼疮活动度量表（SLAM-R）]。通过Cox比例风险回归分析与肺部损害发生时间相关的因素。还绘制了Kaplan-Meier生存曲线。46例（7.3%）患者在平均（标准差）总病程5.3（3.6）年后出现肺部损害。在这些患者中，25例有肺纤维化，12例有肺动脉高压，8例有胸膜纤维化，4例有肺梗死，4例有肺萎陷综合征。7例患者有不止一种类型的肺部损害。5年和10年时肺部损害的累积发生率分别为7.6%和11.6%。在多变量分析中，年龄（HR = 1.033，95%CI 1.006 - 1.060；P = 0.0170）、肺炎（HR = 2.307，95%CI 1.123 - 4.739；P = 0.0229）和抗RNP抗体（HR = 2.344，95%CI 1.190 - 4.618；P = 0.0138）与肺部损害发生时间较短相关，而光过敏（HR = 0.388，95%CI 0.184 - 0.818；P = 0.0128）和口腔溃疡（HR = 0.466，95%CI 0.230 - 0.942；P = 0.0335）与发生时间较长相关。肺部损害在SLE中相对常见。年龄、肺炎和抗RNP抗体与永久性肺部疾病发生时间较短相关。
