Vasculitis in systemic lupus erythematosus
Vasculitis in systemic lupus erythematosus
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DOI：
10.1177/096120339700600304
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发表时间：
1997-01-01
期刊：
影响因子：
2.6
通讯作者：
AlarconSegovia, D
中科院分区：
文献类型：
--
作者：
Drenkard, C;Villa, AR;AlarconSegovia, D
我们研究了667例SLE患者中血管炎的发生频率、部位、临床和组织病理学特征、相关表现和预后。排除既往有血管炎或信息不足的患者后，剩下540例患者，其中194例有血管炎（发病密度：0.053例新发病例/人/年，1年累积发病率为0.051，5年为0.232，10年为0.411）。119例患者发生了一次血管炎发作，75例患者发生了两次或多次血管炎发作。160例为皮肤血管炎，24例为内脏血管炎，10例均为皮肤血管炎。首次发作的皮肤血管炎中，111例有点状病变，32例可触及紫癜，6例荨麻疹，6例溃疡，8例丘疹，5例经活检证实的红斑或斑疹，2例红斑伴坏死，1例脂膜炎（加小血管炎）。首发内脏血管炎29例，多发性单神经炎19例，手指坏死5例，四肢大动脉炎3例，肠系膜血管炎1例，冠状动脉血管炎1例。血管炎患者的病程和随访时间较长，发病年龄较低，且男性多于非血管炎患者。单因素Logistic回归分析显示，与血管炎相关的狼疮表现包括心肌炎、精神病、雷诺现象、浆膜炎、白细胞减少、淋巴细胞减少和胸膜炎。血管炎也与抗磷脂综合征有关。当单独考虑经活检和/或动脉造影证实的血管炎患者时，这种关联的强度增加。控制发病年龄和肾病时内脏血管炎与死亡率增加相关。
We studied the frequency, location, clinical and histopathological features, associated manifestations, and prognosis of vasculitides in a cohort of 667 SLE patients. Exclusion of patients with previous vasculitis or insufficient information left 540 patients, 194 of whom had vasculitis (incidence density: 0.053 new cases/person/year, cumulative incidence of 0.051 at one year, 0.232 at 5 years and 0.411 at 10 years).Vasculitis was confirmed by biopsy in 46 cases, by arteriography in five, and by both in three. A single episode of vasculitis occurred in 119 and two or more in 75 patients. Vasculitis was cutaneous in 160, visceral in 24, both in 10. In the first episode of cutaneous vasculitides, 111 had punctuate lesions, 32 palpable purpura, 6 urticaria, 6 ulcers, 8 papules, 5 erythematous plaques or macules confirmed with biopsy, 2 erythema with necrosis, and 1 panniculitis (plus small vessel vasculitis). Of 29 with visceral vasculitis in the first episode, 19 had mononeuritis multiplex, 5 digital necrosis, 3 large artery vasculitis of limbs, one mesenteric, and one coronary. More than one type could appear simultaneously or in subsequent episodes.Patients with vasculitis had longer disease duration and followup, younger age of onset of SLE, and were more frequently males than those without. Lupus manifestations associated with vasculitis in univariate logistic regression included myocarditis, psychosis, Raynaud's phenomenon, serositis, leukopenia, lymphopenia and pleuritis. Vasculitis also associated with the antiphospholipid syndrome. The strength of this association increased when patients with vasculitis confirmed by biopsy and/or arteriography were considered separately. Visceral vasculitis associated with increased mortality when controlled for age of onset and nephropathy.