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目的:分析狼疮性肾炎(LN)患者的死亡原因及危险因素,探讨减少死亡率的策略。方法:以2003年1月-2012年12月我院住院期间死亡的LN患者56例为研究组,并与同期住院存活的LN患者129例为对照组,比较两组的临床特点、死亡原因和死亡危险因素。结果:LN患者第一位死亡原因为SLE本身(53.5%),其次为感染(21.4%)及心血管疾病(17.9%);与对照组比较,研究组患者的急性肾损伤、慢性肾衰竭进入透析、狼疮脑病、浆膜炎及感染等的发生率明显高于对照组(P<0.05或0.01);狼疮脑病、慢性肾衰竭、SLEDAI升高是LN患者死亡的独立危险因素(OR>1,P<0.05),体重指数(BMI)是LN的保护因素(OR<1,P<0.05)。结论:SLE本身所致多器官功能衰竭是LN的主要死亡原因,采取合理治疗措施,控制狼疮活动,积极治疗狼疮脑病、慢性肾衰竭,防止感染、纠正营养不良,可能有助于降低LN患者的病死率。
Objective: To analyze the causes and risk factors of death in patients with lupus nephritis (LN) and to explore strategies to reduce mortality. Methods: From January 2003 to December 2012, 56 cases of LN patients died during hospitalization in our hospital were enrolled in this study. 129 cases of LN patients surviving in the same period were selected as control group. The clinical features, causes of death and Risk factors of death. Results: The first cause of LN death was SLE itself (53.5%), followed by infection (21.4%) and cardiovascular disease (17.9%). Compared with the control group, acute renal injury and chronic renal failure The incidence of dialysis, lupus encephalopathy, serositis and infection was significantly higher than that of the control group (P <0.05 or 0.01). Lupus encephalopathy, chronic renal failure and elevated SLEDAI were independent risk factors for LN death (OR> 1, P <0.05). Body mass index (BMI) was the protective factor of LN (OR <1, P <0.05). CONCLUSIONS: Multiple organ failure caused by SLE itself is the major cause of LN death. Taking appropriate therapeutic measures to control lupus activity, actively treating lupus encephalopathy, chronic renal failure, preventing infection and correcting malnutrition may help to reduce the risk of LN Case fatality rate.