Systemic lupus erythematosus in India.
Systemic lupus erythematosus in India.
复制标题
印度的系统性红斑狼疮。
作者：
A. Malaviya;A. Chandrasekaran;A. Kumar;P. Shamar
系统性红斑狼疮（SLE）的第一个案例是在1995年从印度报告，随后有两个病例报告，并进一步，一系列的8例，直到1969年。自从1968年在新德里的一个主要教学机构建立了临床免疫学实验室以来，该中心对SLE进行了广泛的研究和报道。从1980年中期开始，印度不同地区的其他几个中心，包括钦奈（旧名马德拉斯）、孟买（旧名孟买）、加尔各答和海德拉巴德，也发表了他们在SLE方面的地区经验。基于这些数据，本报告描述了1366例SLE患者在印度不同地区的临床和实验室特征。关节炎、皮疹、光敏性、癫痫发作和精神病的比例与其他种族组相当。同样，ANA和抗DNA抗体阳性也在其他种族组中观察到的范围内。然而，与其他系列相比，脱发、肾性狼疮、口腔溃疡和神经系统受累的比例更高，与某些种族组相比达到统计学显著性数字。相比之下，血液学表现的比例明显低于一些种族群体。浆膜炎和盘状病变的比例也低于大多数其他种族。抗Sm抗体阳性者的比例介于两个极端之间，非洲人和以色列人最高，中国人和欧洲人最低。其他表现与大多数其他种族群体相当。与北美和欧洲报告相比，印度患者的5年和10年生存率显著较低。这可能与该国的一般公共卫生状况有关，包括医院管理设施不够完善，由于缺乏对疾病的认识而延误诊断，只有严重患者才能到达大城市医院的转诊偏见，或印度人中真正严重的疾病，或这些遗传，环境和/或社会文化因素的组合。主要死亡原因为不可逆性肾损害、感染和神经系统受累。尽管抗心磷脂抗体（ACL）和狼疮抗凝剂（LAC）的患病率相当，但临床抗磷脂综合征明显不常见。遗传学研究显示，与对照组（18%）相比，患者的HLA DR 4（37.5%）明显增加。此外，单倍型B8-DR 3在患者组中常见。
The first case of systemic lupus erythematosus (SLE) was reported from India in 1995 followed by two more case reports and further, a series of eight cases, till 1969. Since the establishment of a clinical immunology laboratory at a major teaching institution in New Delhi in 1968, SLE was extensively studied and reported from that centre. From mid-1980 onwards several other centres in different regions in India including Chennai (old name Madras), Mumbai (old name Bombay), Calcutta and Hydrabad, also published their regional experience on SLE. Based on these data, the present report describes the clinical and laboratory characteristics of 1366 SLE patients seen in different regions of India. Arthritis, rash, photosensitivity, seizures and psychosis were seen in comparable proportions to other racial groups. Similarly, ANA and anti-DNA antibody positivity was also within the range seen in other racial groups. When compared with other series, however, alopecia, renal lupus, oral ulcers and neurological involvement was seen in higher proportions, reaching statistically significant figures in comparison to some racial groups. In contrast, haematological manifestations were seen in significantly less proportions in comparison to some of the racial groups. Serositis and discoid lesions were also seen in lower proportions than in most of other races. The proportion of those with anti-Sm antibodies was in between two extremes of highest among Africans and Israelis and lowest among Chinese and Europeans. Other manifestations were comparable to most other racial groups. Compared to North American and European reports, significantly low 5 and 10 year survival was observed among patients from India. This could be related to the general public health situation in the country including less than optimal management facilities in hospitals, delay in diagnosis due to lack of awareness of the disease, referral bias where only serious patients reach major city hospitals, or a truly severe disease among Indians, or a combination of these genetic, environmental and/or sociocultural factors. The Main causes of death were irreversible renal damage, infections and neurological involvement. Despite a comparable prevalence of anticardiolipin antibodies (aCL) and lupus anticoagulants (LAC), clinical antiphospholipid syndrome was significantly less common. Genetic studies showed appreciable increase of HLA DR4 (37.5%) among patients compared with controls (18%). Additionally the haplotype B8-DR3 was encountered frequently in the patient group.