Associations of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus
Associations of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus
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系统性红斑狼疮患者临床特征和预后与发病年龄的关系
DOI：
10.1177/0961203313513508
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发表时间：
2014-03-01
期刊：
影响因子：
2.6
通讯作者：
Sun, L.
中科院分区：
文献类型：
--
作者：
Feng, X.;Zou, Y.;Sun, L.
本研究的目的是在一个大的、多中心的中国队列中评价系统性红斑狼疮（SLE）患者的临床特征和预后与发病年龄的关系。本文对15所医院1898例SLE住院患者的病历资料进行了回顾性分析。分类资料采用卡方检验，潜在相关因素采用多项logistic回归分析。在研究的患者中，259例（13.6%）为青少年发作（≤18岁），1444例（76.1%）为早发性（>18岁且≤45岁），195例（10.3%）为晚发性（>45岁）。无论何时出现症状，大多数患者（>80%）在两年内被诊断出来。青少年发病的SLE患者更可能在入院前未经治疗（p < 0.001），并有皮肤粘膜表现（p < 0.001），但肌肉骨骼症状（p < 0.05）和白细胞减少症（p < 0.05）较少发生，而晚发性SLE患者的合并症要高得多（p < 0.001）。神经精神、心肺、肾脏和胃肠道受累、疾病活动指数和损害评分在三组之间相似。抗Sm抗体在晚发型患者中较不普遍（p < 0.05），抗疟药物更常用于青少年发病患者（p < 0.001）。正如预期的那样，晚发性SLE组的死亡率升高（p < 0.05），其中近一半死于感染，远高于其他两组（p < 0.001）。Logistic回归分析证实，与晚发性狼疮患者相比，青少年和早发性疾病患者入院前未经治疗的发生率较高，合并症的发生率较低，感染导致的死亡率较低。有趣的是，我们的数据显示，更多的晚发性疾病患者在出院时SLEDAI评分变化>7。总之，发病年龄对SLE疾病状态有影响，感染是晚发性狼疮患者死亡的主要原因。考虑到晚发型患者同时具有易于控制的疾病和高并发症发生率，应考虑与年轻患者不同的治疗策略。
The objective of this study is to evaluate the association of clinical features and prognosis with age at disease onset in patients with systemic lupus erythematosus (SLE) in a large, multicenter Chinese cohort. Medical records of 1898 SLE inpatients from 15 hospitals were reviewed and classified into three groups according to their ages at disease presentation. Categorical data were analyzed by chi-square test and potentially associated factors were tested by multinomial logistic regression. Among the patients studied, 259 (13.6%) were juvenile onset (≤18 years), 1444 (76.1%) were early onset (>18 and ≤45 years) and 195 (10.3%) were late onset (>45 years). Whenever manifestations occurred, most patients (>80%) were diagnosed within two years. Juvenile-onset patients were more likely to be untreated before admission (p < 0.001) and have mucocutaneous manifestations (p < 0.001), but musculoskeletal symptoms (p < 0.05) and leukopenia (p < 0.05) were less frequent, while comorbidities were much higher in patients with late-onset SLE (p < 0.001). Neuropsychiatric, cardiopulmonary, renal and gastrointestinal involvement, disease activity index and damage scores were similar among three groups. Anti-Sm antibodies were less prevalent in late-onset patients (p < 0.05) and antimalarial drugs were more often applied to juvenile-onset patients (p < 0.001). As expected, mortality was elevated in the late-onset SLE group (p < 0.05), in which nearly half died of infections, which was much higher than those in the other two groups (p < 0.001). Logistic regression confirmed that patients with juvenile- and early-onset disease were associated with high incidence of being untreated prior to admission, and with low incidence of comorbidities as well as deaths caused by infection compared to patients with late-onset lupus. Interestingly, our data showed that more patients with late-onset disease had a SLEDAI score change of >7 at discharge. In conclusion, age at onset has an impact on SLE disease status, and infection is the main cause of death in those with late-onset lupus. Considering that the late-onset patients had simultaneously easily controllable diseases and high incidence of comorbidities, a different treatment strategy from younger patients should be considered.