Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Division of Rheumatology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, P.O. Bertsham, Johannesburg, 2013, South Africa.
Clin Rheumatol. 2019 Aug;38(8):2077-2082. doi: 10.1007/s10067-019-04511-7. Epub 2019 Apr 8.
To investigate the prevalence and spectrum of comorbidities in South Africans with systemic lupus erythematosus (SLE).
A nested case-control study of a known alive group (AG) and deceased group (DG) of 200 and 40 patients, respectively, matched for age and sex, attending a tertiary Lupus Clinic. Comorbidities that were documented included, but not restricted to, those listed in the Charlson comorbidity index (CCI). Lupus disease severity was assessed using the lupus severity index (LSI).
Patients were mainly black female (94%), and the median age (IQR) and median disease duration (IQR) were 33 (25-42) and 6 (3-11) years, respectively. Overall, 191 (79.5%) patients experienced ≥ 1 comorbidities. The median (IQR) LSI and CCI scores were significantly higher in the DG than the AG (8.5 (6.7-9.1) vs 6.3 (5.2-8.3), p < 0.001 and 1 (1-3) vs 0 (0-2), p = 0.002, respectively). The commonest comorbidities were hypertension (42%), serious infections (36.6%) and tuberculosis (TB) (18.8%), the latter two being significantly more common in the DG (OR = 7.34, p < 0.0001 and OR = 3.40, p = 0.001, respectively). Of the CCI comorbidities, congestive cardiac failure (OR = 10.39, p = 0.0003), cerebrovascular disease (OR = 7.29, p = 0.01) and chronic kidney disease (OR = 3.08, p = 0.02) were more common in the DG. Both serious infections and TB were independent predictors of death.
In this study of predominantly black South African SLE patients, comorbidities were common, with serious infections and TB amongst the commonest comorbidities. Unlike in industrialised Caucasian populations, cardiovascular comorbidities were rare in spite of a high prevalence of HPT.
研究系统性红斑狼疮（SLE）南非患者的合并症患病率和种类。
对一个已知存活组（AG）和死亡组（DG）的 200 名和 40 名患者进行嵌套病例对照研究，年龄和性别匹配，分别接受三级狼疮诊所治疗。记录的合并症包括但不限于 Charlson 合并症指数（CCI）中列出的那些。使用狼疮严重程度指数（LSI）评估狼疮疾病严重程度。
患者主要为黑人女性（94%），中位年龄（IQR）和中位疾病持续时间（IQR）分别为 33（25-42）和 6（3-11）年。总体而言，191（79.5%）名患者经历了≥1种合并症。DG 的中位（IQR）LSI 和 CCI 评分明显高于 AG（8.5（6.7-9.1）比 6.3（5.2-8.3），p<0.001 和 1（1-3）比 0（0-2），p=0.002）。最常见的合并症是高血压（42%）、严重感染（36.6%）和结核病（TB）（18.8%），后两种疾病在 DG 中更为常见（OR=7.34，p<0.0001 和 OR=3.40，p=0.001）。CCI 合并症中，充血性心力衰竭（OR=10.39，p=0.0003）、脑血管疾病（OR=7.29，p=0.01）和慢性肾脏病（OR=3.08，p=0.02）在 DG 中更为常见。严重感染和结核病都是死亡的独立预测因素。
在这项主要为南非黑人 SLE 患者的研究中，合并症很常见，严重感染和结核病是最常见的合并症。与工业化白种人群不同，尽管 HPT 患病率高，但心血管合并症很少见。
