Szeto C C, Li P K, Wong T Y, Leung C B, Lui S F
Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T.
J Rheumatol. 1998 Aug;25(8):1520-5.
Activity of systemic lupus erythematosus (SLE) often declines after patients reach endstage renal disease (ESRD). However, extrarenal activity is not uncommon, especially during the first few years of dialysis. We reviewed the clinical course of SLE patients with ESRD treated in our unit over the past 10 years, and tried to identify factors associated with postdialysis activity.
A retrospective study of 18 patients with SLE (6 males) who received maintenance dialysis in our center from 1987 to 1996. Their clinical details, organ system manifestations, serologic profile, and treatment were reviewed. Patients with and without lupus flares after maintenance dialysis were compared.
Duration of followup was 43.4 +/- 32.7 months before dialysis and 33.8 +/- 28.9 months afterwards (4 hemodialysis, 14 peritoneal dialysis). Nine patients experienced 32 lupus postdialysis flares. The frequency was 0.63 flare per patient-year. Twenty flares (62.5%) developed within the first year of dialysis. Compared with the other 9 patients who had no flares, patients with flares were younger (median age at diagnosis of SLE 24 vs 33 years; median age when dialysis was initiated 26 vs 37 years; p < 0.05 both, Mann-Whitney U test) and more likely to have history of seizure (6 in 9 vs 1 in 9 patients, p < 0.05, Fisher's exact test). There was a trend that patients with history of serositis and vasculitis were also associated with postdialysis activity, although this was not statistically significant.
Postdialysis flare of SLE is not uncommon, particularly during first year of dialysis. Younger patients and those with history of seizure may have higher risk of postdialysis lupus flare. Careful followup is warranted, especially in potential transplant recipients.
系统性红斑狼疮（SLE）患者进入终末期肾病（ESRD）后，其疾病活动度常下降。然而，肾外活动并不少见，尤其是在透析的最初几年。我们回顾了过去10年在本单位接受治疗的ESRD的SLE患者的临床病程，并试图确定与透析后疾病活动相关的因素。
对1987年至1996年在本中心接受维持性透析的18例SLE患者（6例男性）进行回顾性研究。回顾了他们的临床细节、器官系统表现、血清学特征和治疗情况。比较维持性透析后有无狼疮发作的患者。
透析前随访时间为43.4±32.7个月，透析后为33.8±28.9个月（4例血液透析，14例腹膜透析）。9例患者经历了32次透析后狼疮发作。发作频率为每位患者每年0.63次。20次发作（62.5%）发生在透析的第一年。与其他9例未发作的患者相比，发作患者更年轻（SLE诊断时的中位年龄分别为24岁和33岁；开始透析时的中位年龄分别为26岁和37岁；两者均p<0.05，Mann-Whitney U检验），且更可能有癫痫病史（9例中有6例，9例中有1例，p<0.05，Fisher精确检验）。有浆膜炎和血管炎病史的患者也有透析后疾病活动的趋势，尽管这在统计学上不显著。
SLE透析后发作并不少见，尤其是在透析的第一年。年轻患者和有癫痫病史的患者透析后狼疮发作的风险可能更高。需要仔细随访，尤其是在潜在的移植受者中。
