Andrade R M, Alarcón G S, González L A, Fernández M, Apte M, Vilá L M, McGwin G, Reveille J D
Department of Medicine, Schools of Medicine and Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ann Rheum Dis. 2008 Jun;67(6):829-34. doi: 10.1136/ard.2007.077594. Epub 2007 Sep 17.
To examine the predictors of time-to-seizure occurrence and their impact on damage accrual and mortality in LUMINA, a multiethnic (Hispanic, African American and Caucasian) cohort of patients with systemic lupus erythematosus.
Seizures were defined as per the American College of Rheumatology (ARC) nomenclature and case definitions for neuropsychiatric lupus syndromes. Factors associated with time-to-seizure occurrence occurring at or after diagnosis (TD) of systemic lupus erythematosus were examined by univariable and multivariable Cox proportional hazard regression analyses. The impact of seizures on damage accrual and mortality was also examined by multivariable analyses after adjusting for variables known to affect these outcomes.
A total of 600 patients were included in these analyses. Of them, 40 (6.7%) developed seizures at or after TD; by multivariable analyses, disease activity and younger age were independent predictors of a shorter time-to-seizure occurrence (HR = 1.10 and 1.04; 95% CI 1.04 to 1.15 and 1.00 to 1.08, p = 0.0004 and 0.0304, respectively) whereas mucocutaneous involvement (HR = 0.34, 95% CI 0.16 to 0.41, p = 0.0039) and hydroxychloroquine use (HR = 0.35, 95% CI 0.15 to 0.80, p = 0.0131) were independent predictors of a longer time-to-seizure occurrence. Seizures were an independent contributor to damage accrual but not to mortality.
Seizures tend to occur early in the course of systemic lupus erythematosus, and contribute to damage accrual. Younger age and disease activity are independent predictors of a shorter time-to-seizure occurrence; antimalarials appear to have a protective role in seizure occurrence.
在LUMINA（一个多民族[西班牙裔、非裔美国人和白种人]系统性红斑狼疮患者队列）中，研究癫痫发作时间的预测因素及其对损伤累积和死亡率的影响。
根据美国风湿病学会（ARC）的术语和神经精神性狼疮综合征的病例定义来定义癫痫发作。通过单变量和多变量Cox比例风险回归分析，研究与系统性红斑狼疮诊断后（TD）癫痫发作时间相关的因素。在调整已知影响这些结果的变量后，通过多变量分析也研究了癫痫发作对损伤累积和死亡率的影响。
这些分析共纳入600例患者。其中，40例（6.7%）在TD时或之后发生癫痫发作；通过多变量分析，疾病活动度和较年轻年龄是癫痫发作时间较短的独立预测因素（HR = 1.10和1.04；95% CI为1.04至1.15和1.00至1.08，p分别为0.0004和0.0304），而黏膜皮肤受累（HR = 0.34，95% CI为0.16至0.41，p = 0.0039）和使用羟氯喹（HR = 0.35，95% CI为0.15至0.80，p = 0.0131）是癫痫发作时间较长的独立预测因素。癫痫发作是损伤累积的独立因素，但不是死亡率的独立因素。
癫痫发作往往在系统性红斑狼疮病程早期发生，并导致损伤累积。较年轻年龄和疾病活动度是癫痫发作时间较短的独立预测因素；抗疟药似乎在癫痫发作方面具有保护作用。
