马来西亚男性患者中的系统性红斑狼疮：我们与其他地理区域有何不同？

Systemic lupus erythematosus among male patients in Malaysia: how are we different from other geographical regions?

作者信息

Shaharir S S, Kadir W D Abdul, Nordin F, Bakar F Abu, Ting M W H, Jamil A, Mohd R, Wahab A Abdul

机构信息

1 Rheumatology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur.

2 Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur.

出版信息

Lupus. 2019 Jan;28(1):137-144. doi: 10.1177/0961203318812676. Epub 2018 Nov 20.

DOI:10.1177/0961203318812676

PMID:30458692

Abstract

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disease which predominantly affects females. The disease characteristics in male SLE patients are reported to be distinct and may vary across ethnicities and geographical regions.

OBJECTIVE

To determine and compare the clinical phenotype and organ damage between male and female patients with SLE in Malaysia.

METHODOLOGY

This was a cross-sectional study involving SLE patients from Universiti Kebangsaan Malaysia Medical Centre from June 2016 until June 2017. Information on their socio-demographics and disease characteristics were obtained from the clinical records. Disease damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) scores. The disease characteristics, autoantibody profiles and organ damage were compared between male and female patients, and multivariable analysis using male sex as dependent variable was then performed.

RESULTS

A total of 418 patients were recruited and a total of 59 (14.1%) patients were male. Male patients presented with lower SLE ACR criteria at initial presentation but a significantly higher number of them had renal involvement (lupus nephritis) (78.0% versus 63.8%, p = 0.04). Male patients had less musculoskeletal involvement (45.8% versus 63.0%, p = 0.02) and tended to have lesser mucocutaneous involvement. Immunologic profile revealed that a lower number of male patients had positive anti-Ro antibody (22.7% versus 44.7%, p = 0.04) and they tended to have positive lupus anticoagulant antibody (27.6% versus 14.3%, p = 0.06). Presence of organ damage (SDI score ≥ 1) was significantly higher among males (55.9% versus 39.6%, p = 0.02) with higher renal damage (25.4% versus 9.2%, p = 0.004) and cardiovascular event of ischaemic heart disease or stroke (20.3% versus 7.0%, p = 0.004). They were also inclined to develop damage much earlier as compared to female patients, 3 (interquartile range (IQR) 7.5) versus 5 (IQR 7) years, p = 0.08. The occurrence of disease damage was independently associated with male gender with odds ratio of 1.9 (95% confidence interval 1.1-3.5), p = 0.02.

CONCLUSION

Male patients with SLE have more severe disease with renal damage and cardiovascular event.

摘要

背景

系统性红斑狼疮（SLE）是一种主要影响女性的自身免疫性疾病。据报道，男性SLE患者的疾病特征有所不同，并且可能因种族和地理区域而异。

目的

确定并比较马来西亚男性和女性SLE患者的临床表型和器官损害情况。

方法

这是一项横断面研究，纳入了2016年6月至2017年6月来自马来西亚国民大学医学中心的SLE患者。从临床记录中获取他们的社会人口统计学信息和疾病特征。使用系统性红斑狼疮国际协作临床/美国风湿病学会（SLICC/ACR）损伤指数（SDI）评分评估疾病损害。比较男性和女性患者的疾病特征、自身抗体谱和器官损害情况，然后以男性性别作为因变量进行多变量分析。

结果

共招募了418名患者，其中59名（14.1%）为男性。男性患者初诊时SLE ACR标准较低，但其中有肾脏受累（狼疮性肾炎）的患者比例显著更高（78.0%对63.8%，p = 0.04）。男性患者的肌肉骨骼受累较少（45.8%对63.0%，p = 0.02），且皮肤黏膜受累往往较少。免疫谱显示，男性患者中抗Ro抗体阳性的人数较少（22.7%对44.7%，p = 0.04），且他们往往狼疮抗凝抗体阳性（27.6%对14.3%，p = 0.06）。男性患者中存在器官损害（SDI评分≥1）的比例显著更高（55.9%对39.6%，p = 0.02），肾脏损害更高（25.4%对9.2%，p = 0.004），缺血性心脏病或中风的心血管事件发生率更高（20.3%对7.0%，p = 0.004）。与女性患者相比，他们也倾向于更早出现损害，分别为3（四分位间距（IQR）7.5）年对5（IQR 7）年，p = 0.08。疾病损害的发生与男性性别独立相关，比值比为1.9（95%置信区间1.1 - 3.5），p = 0.02。