Prevalence, outcome and prognostic factors of neuropsychiatric systemic lupus erythematosus: A real world single center study
Prevalence, outcome and prognostic factors of neuropsychiatric systemic lupus erythematosus: A real world single center study
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DOI：
10.1080/14397595.2019.1589912
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发表时间：
2019-04-06
影响因子：
2.2
通讯作者：
Li, Zhanguo
中科院分区：
文献类型：
--
作者：
Li, Xue;Xiang, Xiaohong;Li, Zhanguo
目的：探讨神经精神性系统性红斑狼疮（NPSLE）的患病率、转归及影响预后的因素。方法：选取2005年至2016年住院的SLE患者。收集生存时间和死亡原因的信息。采用Kaplan-Meier曲线、对数秩检验和考克斯比例风险模型分析数据。结果：1589例SLE患者中，101例（6.4%）被诊断为NPSLE。NPSLE患者的1、3和5年总生存率分别为89%、85%和84%。NPSLE患者的标化死亡比为11.14。最常见的死亡原因是NPSLE相关疾病（7.47%），包括颅内高压综合征、脑血管疾病和运动神经元疾病。以下变量与死亡相关：心脏受累、肾脏受累、弥漫性NPSLE、急性意识模糊状态、一种以上NPSLE表现、淋巴细胞计数低、C反应蛋白升高、脑脊液（CSF）异常和系统性红斑狼疮疾病活动指数高。急性意识模糊状态（p = 0.001）、颅内压升高（p = 0.010）和C反应蛋白（CRP）（p = 0.032）是死亡的独立预测因素。结论：我们的研究表明，NPSLE患者的死亡率比一般人群高11.14倍。NPSLE相关疾病是死亡的主要原因。急性意识模糊状态是预后不良的最重要预测因素。
Objectives: To investigate the prevalence, outcome and prognostic factors of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods: SLE inpatients from 2005 to 2016 were included. Information on survival duration and causes of death was collected. Data were analyzed using Kaplan-Meier curves, log-rank tests and Cox proportional hazards modeling. Results: Among 1589 SLE patients, 101 (6.4%) were diagnosed with NPSLE. The overall survival rates of the NPSLE patients were 89%, 85% and 84% at 1, 3 and 5 years, respectively. The standardized mortality ratio of NPSLE patients was 11.14. The most common cause of death was NPSLE related conditions (7, 47%), including intracranial hypertension syndrome, cerebrovascular disease and motor neuron disease. The following variables were associated with death: cardiac involvement, renal involvement, diffuse NPSLE, acute confusional state, more than one NPSLE manifestation, low lymphocyte count, elevated C-reactive protein, abnormal cerebrospinal fluid (CSF) and high systemic lupus erythematosus disease activity index. Acute confusional state (p = .001), elevated intracranial pressure (p = .010) and C-reactive protein (CRP) (p = .032) were independently predictive factors of death. Conclusion: Our study demonstrates an 11.14-fold increased mortality of NPSLE patients compared with general population. NPSLE related disorders are main causes of death. Acute confusional state is the most significant predictive factor for poor prognosis.