本文選題：重癥狼瘡 + BILAG-2004��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性分析系統(tǒng)性紅斑狼瘡住院患者臨床資料,評估兩種評分標(biāo)準(zhǔn)對重癥狼瘡(Severe Systemic Lupus Erythematosus,SSLE)的診斷識別情況,并對SSLE發(fā)生的相關(guān)因素進(jìn)行分析,同時探討SSLE的預(yù)后,從而為早期識別SSLE,預(yù)防輕、中型SLE轉(zhuǎn)變?yōu)镾SLE,改善患者預(yù)后提供依據(jù)。方法:對2006年12月1日到2016年12月1日入住大連醫(yī)科大學(xué)附屬大連市中心醫(yī)院198例SLE住院患者的臨床資料進(jìn)行回顧性分析。分析包括兩部分:一:采用SLEDAI、BILAG評分標(biāo)準(zhǔn)識別SSLE,依據(jù)2010年中華風(fēng)濕病學(xué)會狼瘡分型標(biāo)準(zhǔn):SLEDAI積分≥15分為SSLE,BILAG評分中,任一系統(tǒng)達(dá)A級或至少三個系統(tǒng)均達(dá)B級為SSLE。符合標(biāo)準(zhǔn)之一即納入SSLE,兩標(biāo)準(zhǔn)均未達(dá)到者計入非SSLE。比較兩組數(shù)據(jù)的差異,評價兩者的敏感性及實(shí)用性。二:采用病例對照研究方法探討SSLE發(fā)生的相關(guān)因素。通過上述兩種標(biāo)準(zhǔn),將SSLE患者病例組與非SSLE患者對照組進(jìn)行比較。收集病例的臨床資料包括性別、民族、職業(yè)、常住地、家族史、妊娠史、臨床表現(xiàn)、疾病活動相關(guān)輔助化驗檢查結(jié)果、治療方案及結(jié)局轉(zhuǎn)歸、住院費(fèi)用等,采用多因素Logistic回歸分析SSLE發(fā)生的相關(guān)危險因素。結(jié)果:1.本研究醫(yī)院10年間SLE住院患者累計198例,共628次住院。通過BILAG-2004評分,符合重癥標(biāo)準(zhǔn)共127例,138次重癥發(fā)作住院;通過SLEDAI-2000評分符合重癥標(biāo)準(zhǔn)共71例,78次重癥發(fā)作住院;同時符合上述兩評分系統(tǒng)的SSLE患者共68例,75次重癥發(fā)作住院;2.符合上述兩評分系統(tǒng)的SSLE共130例(141次重癥發(fā)作住院),占SLE患者總住院次數(shù)22.5%(141/628)。其中不符合BILAG-2004評估SSLE診斷標(biāo)準(zhǔn)3例,共3次重癥發(fā)作住院,但其已達(dá)到BILAG-2004評分系統(tǒng)中度標(biāo)準(zhǔn),且3例都累及5個系統(tǒng),對應(yīng)的SLEDAI-2000評分均≥15分,其評分分別為16分、15分、27分。此130例SSLE不符合SLEDAI-2000SSLE診斷標(biāo)準(zhǔn)59例,共63次重癥發(fā)作住院;這59例患者SLEDAI-2000中位評分值為8分,但BILAG-2004評分均達(dá)SSLE水平,其中33次累及血液系統(tǒng)達(dá)A類,15次累及呼吸循環(huán)系統(tǒng)達(dá)A類,11次累及腎臟達(dá)A類,5次累及消化系統(tǒng)達(dá)A類,4次累及3個以上系統(tǒng)達(dá)B類;3.SSLE組首次發(fā)病以皮膚粘膜系統(tǒng)69例(53.1%)、肌肉骨骼系統(tǒng)47例(36.2%)、一般非特異癥狀系統(tǒng)39例(30%)、泌尿系統(tǒng)28例(21.5%)、血液系統(tǒng)27例(20.8%)、呼吸循環(huán)系統(tǒng)5例(3.8%)、消化系統(tǒng)2例(1.5%)、神經(jīng)系統(tǒng)2例(1.5%)、眼部系統(tǒng)未累及(0%);非SSLE組首次發(fā)病以皮膚粘膜損害系統(tǒng)47例(69.1%),肌肉骨骼系統(tǒng)44例(64.7%)、一般非特異癥狀系統(tǒng)23例(33.8%)、泌尿系統(tǒng)12例(17.6%)、血液系統(tǒng)10例(14.7%)、消化系統(tǒng)2例(2.9%),未有首次以神經(jīng)系統(tǒng)、呼吸循環(huán)系統(tǒng)、眼部系統(tǒng)受累者,上述系統(tǒng)兩組間比較差異均有統(tǒng)計學(xué)意義(P0.05);SSLE主要累及器官包括血液系統(tǒng)120例(85.1%)、泌尿系統(tǒng)95例(67.4%)、皮膚粘膜系統(tǒng)69例(48.9%)、一般非特異癥狀系統(tǒng)62例(44.0%)、呼吸循環(huán)系統(tǒng)53例(37.5%)、神經(jīng)系統(tǒng)32例(22.7%)、消化系統(tǒng)26例(18.4%)、眼部系統(tǒng)1例(0.7%),非SSLE組血液系統(tǒng)36例(52.9%)、泌尿系統(tǒng)20例(29.4%)、皮膚粘膜系統(tǒng)48例(70.6%)、肌肉骨骼系統(tǒng)46例(67.6%),一般非特異癥狀系統(tǒng)有21例(30.9%)、消化系統(tǒng)4例(5.9%)、呼吸循環(huán)系統(tǒng)3例(4.4%)、眼部系統(tǒng)1例(1.5%),未有神經(jīng)系統(tǒng)累及,其中一般非特異癥狀系統(tǒng)、眼部系統(tǒng)比較差異無統(tǒng)計學(xué)意義(P0.05),余系統(tǒng)組間比較差異有統(tǒng)計學(xué)意義(P0.05);4.本組病例男性27例,女性171例,男女比為1:6.3,SSLE組中,男性21例,女性109例,男女比為1:5.2;非SSLE組,男性6例,女性62例,男女比為1:10.3,兩組間比較差異無統(tǒng)計學(xué)意義(P=0.1540.05);SSLE組常住地為大連城市(含城郊)有102例(78.5%),大連農(nóng)村有28例(21.5%),非SSLE組常住地為大連城市(含城郊)有61例(89.7%),大連農(nóng)村有7例(10.3%),SSLE組診斷年齡50歲有84例(64.6%)、診斷年齡≥50歲有46例(35.4%),非SSLE組診斷年齡50歲有54例(79.4%)、診斷年齡≥50歲有14例(20.6%),SSLE組無確切誘因102次(72.3%);有確切誘因者39次(27.7%),非SSLE組無確切誘因61次(89.8%),有確切誘因者7次(10.2%),SSLE組器官系統(tǒng)累及個數(shù)≤3個的有63例(48.5%),累及個數(shù)3個的有67例(51.5%),非SSLE組器官系統(tǒng)累及個數(shù)≤3個的有57例(83.8%),累及個數(shù)3個的有11例(16.2%),常住地、診斷年齡、誘因、器官系統(tǒng)累及個數(shù)組間比較其差異有統(tǒng)計學(xué)意義(P0.05);此外,民族、職業(yè)、發(fā)病年齡、住院年齡、結(jié)核感染史、家族史、女性妊娠流產(chǎn)史、病程等組間比較差異均無統(tǒng)計學(xué)意義(P0.05);5.SSLE組與非SSLE組化驗指標(biāo)分別比較,24h尿蛋白定量、BUN、SCR、TP、ALB、AST、CRP、ESR、C3、C4、IgA、ANA 滴度、抗 SSB 抗體組間比較差異有統(tǒng)計學(xué)意義(P0.05),而ALT、TB、DB、IgG、IgM、抗dsDNA抗體以及除抗SSB抗體的ENA譜的組間差異無統(tǒng)計學(xué)意義(P0.05);6.Logistic回歸分析結(jié)果顯示有無確切誘因、器官系統(tǒng)累及數(shù)是否≥3個、常住農(nóng)村或城市、診斷年齡是否≥50歲、血沉快慢、ANA滴度情況、IgA水平、抗SSB抗體與SSLE的相關(guān)性有統(tǒng)計學(xué)意義(P0.05);7.SSLE組10年間住院患者共有10例死亡,病死率為7.7%(10/130),且以感染、多臟器衰竭為主要死亡原因,而非SSLE組未有死亡病例。結(jié)論:1.BILAG-2004評分、SLEDAI-2000評分結(jié)果顯示前者敏感性遠(yuǎn)高于后者,且與后者符合率高,不易漏診,但前者評估參數(shù)較多,方法較為繁瑣,因此首先推薦應(yīng)用BILAG-2004評估SSLE,條件允許時也可聯(lián)合采用SLEDAI-2000評分診斷 SSLE;2.SSLE以皮膚粘膜系統(tǒng)、肌肉骨骼系統(tǒng)為首發(fā)臨床表現(xiàn);其主要受累器官以血液系統(tǒng)、泌尿系統(tǒng)最常見,此點(diǎn)不同于非SSLE;有確切誘因、器官系統(tǒng)累及個數(shù)越多、常住農(nóng)村、診斷年齡越大、血沉越快、中高滴度ANA、中高水平的IgA、抗SSB抗體陽性是發(fā)生、發(fā)展為SSLE的相關(guān)危險因素,與女性相比男性患者更易發(fā)展為SSLE;3.SSLE住院10年病死率為7.7%(10/130),感染、多臟器衰竭為主要死亡原因。
[Abstract]:Objective: To evaluate the clinical data of patients with systemic lupus erythematosus (SLE), evaluate the diagnosis and identification of Severe Systemic Lupus Erythematosus (SSLE) by two scoring criteria, analyze the related factors of SSLE, and discuss the prognosis of SSLE, so as to identify SSLE, prevent light and moderate SLE transition in early stage. The clinical data of 198 patients hospitalized in Dalian Central Hospital, Dalian Medical University, Dalian Medical University from December 1, 2006 to December 1, 2016 were analyzed retrospectively. The analysis included two parts: 1: using SLEDAI, BILAG standard to identify SSLE, according to the 2010 Chinese rheumatism society Wolf Sore typing standard: SLEDAI score more than 15 points SSLE, BILAG score, any system reached a Class A or at least three systems reached B level as one of the SSLE. conforms to SSLE, two standards were not reached in non SSLE. comparison two groups of data differences, evaluate the sensitivity and practicality of both. Two: case control study method to explore SSLE hair The related factors of birth were compared with those of the control group of the SSLE patients and the non SSLE patients. The clinical data of the cases included sex, nationality, occupation, permanent residence, family history, pregnancy history, clinical manifestation, auxiliary test results of disease activities, treatment scheme and outcome, hospitalization expenses, and so on. Factor Logistic regression analysis of the related risk factors of SSLE. Results: 1. the total number of hospitalized patients with SLE in the 10 years of this study was 198 cases, with a total of 628 hospitalized patients. Through the BILAG-2004 score, 127 cases were conformed to severe criteria and 138 severe attacks were hospitalized; 71 cases were conformed to the severe standard and 78 severe attacks were hospitalized by the SLEDAI-2000 score. A total of 68 SSLE patients and 75 severe episodes were hospitalized in the two scoring system; 2. were in line with the above two scoring system in 130 cases (141 severe episodes of hospitalization), accounting for 22.5% (141/628) of the total hospitalization of the SLE patients, which did not conform to the BILAG-2004 evaluation of the SSLE diagnostic criteria for 3 cases and were hospitalized for 3 severe episodes, but they had reached a moderate BILAG-2004 scoring system. Standard, and 3 cases were involved in 5 systems, the corresponding SLEDAI-2000 scores were more than 15 points, and their scores were 16, 15, 27. 130 cases of SSLE did not conform to the SLEDAI-2000SSLE diagnostic criteria for 59 cases and were hospitalized for 63 severe episodes; the median score of the 59 patients was 8, but the BILAG-2004 score was SSLE level, among which 33 involves the blood involvement of the blood. The system reached a Class A, 15 involvement of the respiratory circulation system as a Class A, 11 times involving the kidney a Class A, 5 times involving the digestive system to a Class A, 4 times involving more than 3 systems to B; the first onset of the 3.SSLE group was 69 cases of the skin and mucous membrane system (53.1%), the musculoskeletal system 47 cases (36.2%), the general non specific symptom system 39 cases (30%), the urinary system 28 cases (21.5%), blood system. 27 cases (20.8%), 5 cases (3.8%) of respiratory and circulation system, 2 cases of digestive system (1.5%), 2 cases of nervous system (1.5%), and no involvement of the eye system (0%). The first onset of non SSLE group was 47 cases (69.1%), 44 cases of musculoskeletal system (64.7%), non specific symptom system, urinary system, blood system. There were 2 cases (2.9%) of digestive system (2.9%). There was no significant difference between the two groups of the two groups (P0.05); SSLE mainly involved organs including blood system (85.1%), urinary system 95 (67.4%), skin and mucous membrane system 69 cases (48.9%), and general nonspecific symptom system 62 cases (4). 4%) respiratory and circulatory system (37.5%), nervous system 32 cases (22.7%), digestive system 26 cases (18.4%), eye system 1 cases (0.7%), non SSLE blood system 36 cases (52.9%), urinary system 20 cases (29.4%), musculoskeletal system, musculoskeletal system and digestive system. There were 3 cases (4.4%) of respiratory circulatory system and 1 cases (1.5%) of eye system. There was no nervous system involvement. There was no statistical difference in the general non specific symptom system (P0.05), and there was significant difference between the remaining system groups (P0.05); 4. cases were male 27, female 171, male and female were 1:6.3, SSLE group, 21 male, female male, female Sex ratio was 109 cases, male and female ratio was 1:5.2; non SSLE group, male 6 cases, female 62 cases, male and female ratio 1:10.3, two groups had no statistical difference (P=0.1540.05); SSLE group was Dalian city (including suburb) 102 cases (78.5%), Dalian rural 28 cases (21.5%), Dalian city (including suburb) of non SSLE group, 61 (89.7%), Dalian rural 7 10.3% (10.3%), 84 cases (64.6%) were diagnosed at the age of 50, 46 (35.4%) aged more than 50 years old, 54 (79.4%) at the age of 50 (79.4%) in the non SSLE group, and there were 14 cases (20.6%) in the diagnosis age more than 50 years, and there were no exact inducements in group SSLE. In group SSLE, there were 63 cases (48.5%) involved in the organ system of less than 3, 67 cases (51.5%) involving a number of 3, 57 (83.8%) involving a number of less than 3 in the non SSLE organ system, and 3 of 11 cases (16.2%) involving the number 3, the diagnosis age, the inducement, and the difference between the organs involved in an array (P0.05); moreover, besides, There was no significant difference between the nationalities, the occupations, the age of the onset, the age of hospitalization, the history of tuberculosis infection, the history of tuberculosis infection, the history of the family, the history of pregnancy abortion, and the course of the disease (P0.05), and the comparison of the 24h urine protein, BUN, SCR, TP, ALB, AST, CRP, and ESR, between the 5.SSLE and the non SSLE group. Learning significance (P0.05), while ALT, TB, DB, IgG, IgM, anti dsDNA antibody and the ENA spectrum of anti SSB antibody were not statistically significant (P0.05); 6.Logistic regression analysis showed whether there was an exact inducement, or whether the organ system was involved in more than 3, living in the countryside or City, whether the age was more than 50 years old, the blood sedimentation rate was slow, ANA titer, levels, The correlation between anti SSB antibody and SSLE was statistically significant (P0.05); there were 10 deaths in the 10 patients in group 7.SSLE and 7.7% (10/130), and the main cause of death was infection and multiple organ failure, but no death in group SSLE. Conclusion: 1.BILAG-2004 scores, SLEDAI-2000 score showed that the former was much more sensitive than the latter, And it is not easy to be diagnosed with the latter, but the former has more parameters and more complicated methods. Therefore, first of all, it is recommended to use BILAG-2004 to evaluate SSLE. When conditions permit, SLEDAI-2000 can also be used to diagnose SSLE; 2.SSLE is the first clinical manifestation of the skin and mucous membrane system and musculoskeletal system; the main involved organ is the blood system, Urinary system is the most common, which is different from non SSLE; there are definite causes, the more the organ system is involved, the more the organ system is involved, the greater the diagnosis age, the faster the blood sedimentation, the high titer ANA, the high level of IgA, the anti SSB antibody positive, the related risk factors of SSLE, and the more likely to develop to the SSLE for the male patients compared with the female; 3.SSLE is 10 years in hospital. The fatality rate was 7.7% (10/130), and infection and multiple organ failure were the main causes of death.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R593.241

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