性别差异与系统性红斑狼疮的临床特征有关。

Gender differences are associated with the clinical features of systemic lupus erythematosus.

机构信息

Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing 100044, China.

出版信息

Chin Med J (Engl). 2012 Jul;125(14):2477-81.

Abstract

BACKGROUND

Systemic lupus erythematosus (SLE) mostly occurred in young women. This study was undertaken to investigate the different clinical characteristics of SLE between male and female patients, and to identify the sex hormone levels and clinical outcomes of different gender in SLE patients.

METHODS

Of the 516 SLE patients admitted to the Peking University People's Hospital from January 2008 to December 2010, 58 were male and 458 were female. Clinical manifestations, laboratory profiles and disease activity scores were evaluated in male and female patients. Sex hormones levels were also compared among male patients.

RESULTS

The median age at SLE onset in male and female patients was 27.2 and 28.6 years, respectively. Compared with female patients, at onset of SLE, male patients showed higher rates of serious renal disease (58.6% vs. 47.2%, P = 0.064), neuropsychiatric SLE (20.7% vs. 12.0%, P = 0.055), and a higher incidence of anti-ds-DNA (25.9% vs. 16.8%, P = 0.069), anti-Sm (17.2% vs. 8.7%, P = 0.002), anti-Ro (46.6% vs. 28.4%, P = 0.004), anti-U1RNP (29.3% vs. 15.3%, P = 0.010), anticardiolipin antibody (25.9% vs. 11.4%, P = 0.004), and decreased C3 levels (67.2% vs. 49.8%, P = 0.009). Systemic lupus erythematosus disease activity index (SLEDAI) scores were higher in men than in women (16.8 vs. 12.8, P = 0.038). Of the 58 male patients, 24 had not received aggressive treatment during the three months prior to the study. Levels of testosterone and dihydroepiandrosterone (DHEA) were lower in male SLE patients than in male healthy controls (P = 0.004 and P = 0.006, respectively). Low serum testosterone was an independent risk factor for the development of lupus nephritis (P = 0.043). Male patients with elevated serum prolactin were at increased risk of developing neuropsychiatric manifestations of SLE (P = 0.081).

CONCLUSION

Early recognition of risk factors and appropriate intervention are essential, which might lead to high disease activity and serious systemic damage in male SLE patients.

摘要

背景

系统性红斑狼疮（SLE）多发生于年轻女性。本研究旨在探讨男女患者 SLE 的不同临床特征，以及识别不同性别 SLE 患者的性激素水平和临床结局。

方法

纳入 2008 年 1 月至 2010 年 12 月期间于北京大学人民医院就诊的 516 例 SLE 患者，其中男性 58 例，女性 458 例。评估男性和女性患者的临床表现、实验室指标和疾病活动评分。并比较男性患者的性激素水平。

结果

男性和女性患者 SLE 发病年龄的中位数分别为 27.2 岁和 28.6 岁。与女性患者相比，男性 SLE 患者在发病时表现出更高的严重肾脏疾病发生率（58.6% vs. 47.2%，P=0.064）、神经精神性 SLE 发生率（20.7% vs. 12.0%，P=0.055）、抗 ds-DNA 抗体阳性率（25.9% vs. 16.8%，P=0.069）、抗 Sm 抗体阳性率（17.2% vs. 8.7%，P=0.002）、抗 Ro 抗体阳性率（46.6% vs. 28.4%，P=0.004）、抗 U1RNP 抗体阳性率（29.3% vs. 15.3%，P=0.010）、抗心磷脂抗体阳性率（25.9% vs. 11.4%，P=0.004），以及 C3 水平降低率（67.2% vs. 49.8%，P=0.009）。男性患者的系统性红斑狼疮疾病活动指数（SLEDAI）评分高于女性患者（16.8 分 vs. 12.8 分，P=0.038）。58 例男性患者中，有 24 例在研究前三个月未接受强化治疗。男性 SLE 患者的睾酮和脱氢表雄酮（DHEA）水平低于男性健康对照组（P=0.004 和 P=0.006）。低血清睾酮是狼疮肾炎发生的独立危险因素（P=0.043）。血清催乳素升高的男性患者发生神经精神性 SLE 的风险增加（P=0.081）。