Division of Allergy-Immunology-Rheumatology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Int J Rheum Dis. 2011 Oct;14(4):353-60. doi: 10.1111/j.1756-185X.2011.01639.x. Epub 2011 Jul 29.
The major cause of death in systemic lupus erythematosus (SLE) is due to the disease activity itself or infection. It is uncertain whether the treatment approach during the last decade prolonged survival in SLE.
Our objective was to identify the causes of death and the factors predictive of mortality and to calculate the survival rate among SLE patients.
We conducted a retrospective study of SLE patients followed up at Srinagarind Hospital, Khon Kaen University, Thailand, between January 1, 1996 and August 31, 2005. Cox regression analysis was used to estimate the probability of survival and assessing factors associated with death. The medical records of 749 SLE patients were reviewed; 66 patients died during the follow-up period.
The mortality rate was 1.2 per 100 person-years. The 5- and 10-year survival rate among our SLE patients was 93% and 87%, respectively. The mean age at death was 34.08 ± 11.75 years and the median disease duration was 48 (1-336) months. One-third of the cases were referred from a local hospital more than 1 month after onset and were associated with a significantly higher risk of mortality than cases referred earlier (P = 0.047). The most common causes of death were opportunistic pulmonary infections and neuropsychiatric lupus. Factors predictive of mortality included: (i) major organ flare more than four times per year; (ii) age at onset > 50 years; (iii) high-dose steroid use and/or immunosuppressive therapy at onset and within 2 weeks prior to death; and (iv) concomitant diabetes mellitus. Protective against mortality was antimalarial use.
系统性红斑狼疮（SLE）的主要死亡原因是疾病活动本身或感染。目前尚不确定过去十年的治疗方法是否延长了 SLE 患者的生存时间。
本研究旨在确定 SLE 患者的死亡原因和死亡预测因素，并计算 SLE 患者的生存率。
我们对 1996 年 1 月 1 日至 2005 年 8 月 31 日在泰国孔敬大学诗琳通医院接受随访的 SLE 患者进行了回顾性研究。采用 Cox 回归分析估计生存率，并评估与死亡相关的因素。共回顾了 749 例 SLE 患者的病历，随访期间有 66 例死亡。
死亡率为 1.2/100 人年。我们的 SLE 患者的 5 年和 10 年生存率分别为 93%和 87%。死亡时的平均年龄为 34.08 ± 11.75 岁，中位病程为 48（1-336）个月。有三分之一的病例是在发病后 1 个月以上从当地医院转诊过来的，与更早转诊的病例相比，死亡风险显著更高（P = 0.047）。最常见的死亡原因是机会性肺部感染和神经精神狼疮。死亡的预测因素包括：（i）每年出现 4 次以上主要器官发作；（ii）发病年龄 > 50 岁；（iii）发病时和死亡前 2 周内大剂量使用类固醇和/或免疫抑制治疗；（iv）合并糖尿病。使用抗疟药可预防死亡。
