皮疹与系统性红斑狼疮的预后和内脏受累风险的相关性  

Correlation Between Rashes and Risk of Prognosis and Organ-involvement in Patients with Systemic Lupus Erythematosus

作　　者：曹文婷[1] 杨继春 王晶莹[3] 袁李梅[1] 郭芸[1] 张佩莲[1] 杨滨宾 毕云凤[1] 徐双艳 邓丹琪[1] CAO Wenting;YANG Jichun;WANG Jingying;YUAN Limei;GUO Yun;ZHANG Peilian;YANG Binbin;BI Yunfeng;XU Shuangyan;DENG Danqi(Department of Dermatology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of Science and Technology Education,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of STD and AIDS Control,Kunming Center for Disease Control and Prevention,Kunming 650228,China)

机构地区：[1]昆明医科大学第二附属医院皮肤科,云南昆明650101 [2]昆明医科大学第二附属医院科技教育处,云南昆明650101 [3]昆明市疾病预防控制中心性病艾滋病防制科,云南昆明650228

出　　处：《中国皮肤性病学杂志》2021年第7期732-739,共8页The Chinese Journal of Dermatovenereology

基　　金：国家自然科学基金(81460472,81660517,81860552);云南省应用基础研究计划(2014FB050,2019FE001(-148));云南省卫生科技计划(2017NS312,2018NS0322)。

摘　　要：目的探索伴有与不伴有皮疹的系统性红斑狼疮(systemic lupus erythematosus,SLE)患者预后和出现内脏受累的风险。方法对2002年1月-2019年6月在昆明医科大学第二附属医院就诊的379例无皮疹和1075例有皮疹SLE患者的住院资料进行回顾性分析。有皮疹患者进一步分为皮疹逐渐出现组、皮疹逐渐消退组和持续性皮疹组进行亚组分析。比较各组间的临床特征、实验室指标、肾脏病理分型和死亡率有无差异。结果1454例SLE患者中,男141例,女1313例。无皮疹患者发病年龄(34岁)明显大于有皮疹患者(27岁,P<0.001)。各组间的全因死亡率差异无统计学意义。有持续性冻疮样皮疹的患者全因死亡率比无冻疮样皮疹的患者更高(P=0.002)。无皮疹组和皮疹逐渐消退组的患者,比皮疹逐渐出现组和持续性皮疹组的患者肺部感染(P<0.001)、胸腔积液(P=0.01)、肾脏受累(P=0.005)、胃肠道症状(P=0.02)、室性早搏(P=0.03)和贫血(P=0.03)的发生率更高。而皮疹逐渐出现组和持续性皮疹组的患者,比无皮疹组和皮疹逐渐消退组的患者光敏感(P<0.001)、关节炎(P=0.004)、血管炎(P<0.001)、冻疮(P=0.025)及自身抗体阳性的发生率更高。与有皮疹的患者(包括其亚组)相比,无皮疹的患者的肾脏病理分型更轻(P=0.004)。结论有持续性冻疮样皮疹的患者预后较差。无皮疹和皮疹逐渐消退的患者比皮疹逐渐出现和持续性皮疹的患者更容易出现内脏受累,但无皮疹的患者比有皮疹的患者及其亚组肾脏受累程度较轻。Objective To study the correlation between rashes,prognosis and organ involvement in patients with systemic lupus erythematosus.Methods From January 2002 to June 2019,data from 1454 patients with SLE,1075 patients with rashes and 307 patients without,were retrospectively analyzed.Patients with rashes were subdivided into those with gradually developing rashes,gradually disappearing rashes,and persistent rashes.Clinical features of patients without rashes were compared within the subgroup and with patients with rashes.Results There were 1454 patients with SLE,1313 were women and 141 were men.The age at disease onset of patients without rashes(34 years-old)was significantly higher than that of patients with rashes(27 yearsold,P<0.0001).There was no statistically significant difference in all-cause mortality among the groups.The all-cause mortality rate of patients with persistent chilblain rashes was higher than that of patients without chilblain rashes(P=0.002).Patients without rashes and those with gradually disappearing rashes had higher frequencies of lung infections(P<0.001),pleural effusions(P=0.01),kidney involvement(P=0.005),gastrointestinal symptoms(P=0.02),ventricular premature beats(P=0.03),and anemia(P=0.03)than those with gradually developing rashes and persistent rashes.Patients with gradually developing rashes and those with persistent rashes had higher frequencies of photosensitivity(P<0.001),arthritis(P=0.004),vasculitis(P<0.001),chilblains(P=0.025)and higher titers of autoantibodies than those without rashes and with gradually disappearing rashes.Patients without rashes had milder renal pathological classifications than those with rashes and the subgroups(P=0.004).Conclusion Patients with persistent chilblain rashes have a poorer prognosis.Patients without rashes and those with gradually disappearing rashes are more likely to develop organ involvement than patients with gradually developing rashes and those with persistent rashes.However,patients without rashes have milder renal involvement than t

关 键 词：系统性红斑狼疮 皮疹 光敏性 队列研究 

分 类 号：R593.24[医药卫生—内科学]