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目的 探讨系统性红斑狼疮 (SLE)患者的长期预后及其影响因素。方法 对 5 0例SLE患者进行 18年 ( 1980— 1998年 )定群随访。结果 以发病时间计算其 1、5、10、15、18年生存率分别为 98%、98%、84 %、76%、70 %。死亡原因中 ,感染和肾衰为两大主要原因 ,各为 3 1%。比例风险析模型 (Cox回归 )分析表明诊断时符合ARA标准≥ 7项及血管炎是独立的预后影响因素 (P <0 0 5 )。 13例 ( 2 6% )患者临床缓解 ,平均停药 12 ( 2～ 17)年。结论 通过及时有效的治疗 ,SLE患者完全有可能长期缓解 ,其远期疗效与能否定期专科门诊随访密切相关。预防感染和肾衰、小剂量联合应用免疫抑制剂降低激素用量是进一步提高SLE患者生存率的关键。
Objective To investigate the long-term prognosis and its influencing factors in patients with systemic lupus erythematosus (SLE). Methods Fifty patients with SLE were followed up for 18 years (1980-1998). Results The survival rates at 1, 5, 10, 15 and 18 years were 98%, 98%, 84%, 76% and 70% respectively according to the time of onset. Among the causes of death, infection and renal failure were the two main causes, each at 31%. Proportional risk analysis (Cox regression) analysis showed that ARA criteria ≥ 7 at diagnosis and vasculitis were independent prognostic factors (P <0.05). Thirteen patients (26%) had clinical remission with an average withdrawal of 12 (2-17) years. Conclusion With prompt and effective treatment, patients with SLE are likely to have long-term remission, and its long-term efficacy is closely related to the ability of regular specialist out-patient follow-up. Prevention of infection and renal failure, low-dose combination of immunosuppressive agents to reduce the amount of hormones is to further improve the survival rate of patients with SLE key.