Feng Xuebing, Pan Wenyou, Liu Lin, Wu Min, Ding Fuwan, Hu Huaixia, Ding Xiang, Wei Hua, Zou Yaohong, Qian Xian, Wang Meimei, Wu Jian, Tao Juan, Tan Jun, Da Zhanyun, Zhang Miaojia, Li Jing, Sun Lingyun
Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Department of Rheumatology, Huaian First People's Hospital, Huaian, China.
PLoS One. 2016 Dec 28;11(12):e0168619. doi: 10.1371/journal.pone.0168619. eCollection 2016.
To identify early signs associated with poor prognosis in Chinese patients with systemic lupus erythematosus (SLE) through a large population-based follow-up study.
Medical records of > 2,500 SLE patients that first hospitalized between 1999-2009 were collected from 26 centers across Jiangsu province, China, and entered into a database. These patients were followed-up for 5 to 15 years, and those remained contact and had known survival status in 2015 were assessed for the association of factors presented at the initial hospitalization with mortality at two time points (≤1year and > 1year). The independency of mortality factors was evaluated using multivariate Cox regression analysis.
Among 1,372 patients we assessed, 92.3% were women and 17.2% were deceased in 2015. The main causes of death were infection (30.1%), neuropsychiatric impairment (14.8%), renal failure (14.4%) and cardiopulmonary involvement (8.5%). Hazard ratios (HR) of independent predictors for mortality (≤1year and > 1year, respectively) included hospital presentation of neuropsychiatric involvement (2.03 and 1.91), cardiopulmonary involvement (1.94 and 1.61) and increased serum creatinine (2.52 and 2.58). Patients older than 45 years and with disease durations more than 2 years at admission had unfavorable short-term outcome (HR 1.76 and 1.79), while the presence of anti-dsDNA and anti-Sm antibodies indicated diverse prognosis after 1 year (HR 1.60 and 0.45). Treatment with cyclophosphamide was beneficial for patient's first-year outcome (HR 0.50), and anti-malarial drugs significantly reduced the risk of mortality over different time points (HR 0.48 and 0.54). SLEDAI score, proteinuria or hypocomplementemia was not independently associated with the outcome in this cohort.
SLE patients presented with vital organ damages rather than active disease at initial hospitalization are likely to have a poor outcome, especially for those with neuropsychiatric, cardiopulmonary involvements and renal insufficiency. Early and effective intervention with the use of anti-malarial drugs may decrease mortality.
通过一项基于大样本人群的随访研究，确定中国系统性红斑狼疮（SLE）患者预后不良的早期迹象。
从中国江苏省26个中心收集了2500多名1999年至2009年首次住院的SLE患者的病历，并录入数据库。对这些患者进行了5至15年的随访，对那些在2015年仍保持联系且已知生存状态的患者，评估初始住院时出现的因素与两个时间点（≤1年和>1年）死亡率的相关性。使用多变量Cox回归分析评估死亡因素的独立性。
在我们评估的1372例患者中，92.3%为女性，2015年17.2%的患者死亡。主要死亡原因是感染（30.1%）、神经精神损害（14.8%）、肾衰竭（14.4%）和心肺受累（8.5%）。死亡率独立预测因素的风险比（HR）（分别为≤1年和>1年）包括神经精神受累的住院表现（2.03和1.91）、心肺受累（1.94和1.61）和血清肌酐升高（2.52和2.58）。年龄大于45岁且入院时病程超过2年的患者短期预后不良（HR 1.76和1.79），而抗双链DNA和抗Sm抗体的存在表明1年后预后不同（HR 1.60和0.45）。环磷酰胺治疗对患者的第一年预后有益（HR 0.50），抗疟药在不同时间点显著降低了死亡风险（HR 0.48和0.54）。在该队列中，SLEDAI评分、蛋白尿或低补体血症与预后无独立相关性。
初始住院时出现重要器官损害而非疾病活动的SLE患者可能预后不良，尤其是那些有神经精神、心肺受累和肾功能不全的患者。早期使用抗疟药进行有效干预可能会降低死亡率。
