Murali R, Jeyaseelan L, Rajaratnam S, John L, Ganesh A
Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Natl Med J India. 1997 Jul-Aug;10(4):159-64.
There have been several studies on survival patterns in Indian patients with systemic lupus erythematosus but it is still not clear as to which factors at diagnosis predict survival outcome. The impact of specific organ involvement, and of disease activity itself, needs to be studied further.
We conducted a non-concurrent prospective study of 98 lupus patients between 1981 and 1993. The clinical symptoms, signs and investigation results at onset, and at subsequent visits, were abstracted from the case notes. A systemic lupus erythematosus disease activity index (SLEDAI) was constructed at the initial presentation and for each subsequent visit. Patients not attending for at least 6 months were traced by post. The quantitative data from the SLEDAI was used to construct a Markov chain mathematical expression designed to predict life expectancy.
The cumulative percentage survival at 1, 5 and 10 years was found to be 89%, 77% and 60%, respectively. The Markov chain predicted a life expectancy of 13.9 years. Central nervous system and renal involvement were poor prognostic factors. Proteinuria (> 0.5 g/day) caused a 50% reduction in life expectancy but increased disease activity at onset did not predispose to a poor outcome.
The survival of patients with systemic lupus erythematosus continues to be poor. Central nervous system and renal disease indicate a poor outcome. Hence, new treatment strategies must be evolved to improve the survival of such patients.
针对印度系统性红斑狼疮患者的生存模式已有多项研究，但仍不清楚诊断时哪些因素可预测生存结果。特定器官受累以及疾病活动本身的影响仍需进一步研究。
我们在1981年至1993年间对98例狼疮患者进行了非同期前瞻性研究。从病历中提取发病时及后续就诊时的临床症状、体征和检查结果。在初次就诊及每次后续就诊时构建系统性红斑狼疮疾病活动指数（SLEDAI）。对至少6个月未就诊的患者通过邮寄方式进行追踪。利用SLEDAI的定量数据构建一个马尔可夫链数学表达式来预测预期寿命。
发现1年、5年和10年的累积生存率分别为89%、77%和60%。马尔可夫链预测预期寿命为13.9年。中枢神经系统和肾脏受累是不良预后因素。蛋白尿（>0.5克/天）使预期寿命降低50%，但发病时疾病活动度增加并未导致不良预后。
系统性红斑狼疮患者的生存率仍然较低。中枢神经系统和肾脏疾病提示预后不良。因此，必须制定新的治疗策略以提高此类患者的生存率。
