摘要
目的 探索儿童SLE出现疗效不佳的危险因素.方法 回顾性分析收治本院的儿童SLE初发患者的临床资料、诊治情况和随访资料,根据治疗6个月时的疗效,分为治疗有效组和疗效不佳组,应用SPSS 16.0软件对2组患儿进行分析比较,对计量资料进行t检验,对计数资料进行x2检验,然后对有统计学意义的单因素进行受试者工作（ROC）曲线分析,并作进一步的Logistic回归分析.结果 82例SLE初发患儿中,治疗有效组72例,疗效不佳组10例.疗效不佳组中男童更常见（5/10和12/72,χ2=5.937,P=0.015）,浮肿的发生率更高（10/10和25/72,χ2=15.294,P＜0.01）,浆膜炎的发生率更高（8/10和25/72,χ2=7.485,P=0.006）,更容易出现Coombs＇试验阳性（7/8和14/29,x2=3.931,P=0.047）,肾脏病理分型以Ⅳ或Ⅳ＋Ⅴ型者（8/9和6/30,χ2=14.278,P＜0.01）居多.疗效不佳组患儿的血红蛋白（P=0.013）、血浆白蛋白（P=0.001）、血浆球蛋白（P=0.004）、内生肌酐清除率（Ccr） （P＜0.01）、血钙（P=0.040）及血免疫球蛋白（P=0.006）均低于治疗有效组,血钾（P=0.011）、血磷（P=0.035）、尿蛋白定量（24 h）（P=0.001）和SLEDAI评分（P=0.002）均高于治疗有效组.内生肌酐清除率＜75.91 ml ·min-1·1.73 m-2、尿蛋白定量（24 h）＞1 771.5 mg和SLEDAI＞ 11.5可作为诊断截断点预测SLE患儿发生疗效不佳.Logistic回归分析显示,Ccr是影响SLE预后的危险因素（P=0.043）,OR为23.9,95％CI为1.10～516.8.结论 SLE男童的疗效相对较差,内生肌酐清除率＜75.91 ml·min-1· 1.73 m-2、尿蛋白定量（24 h）＞1 771.5 mg和SLEDAI＞1 1.5可作为预测SLE患儿疗效不佳的定量指标,有自身免疫性溶血性贫血的SLE患儿也可能会出现疗效不佳。
Objective To investigate the risk factors for poor response to treatment in juvenile-onset systemic lupus erythematosus （SLE）.Methods The clinical manifestations,treatment and follow up data of the initial onset SLE patients in our hospital were collected retrospectively.According to the response to treatment after 6 months,patients were divided in two groups.One was treatment effective group,and the other was poor response group.The data of the two groups were analyzed by SPSS 16.0 Counted data were analyzed by Chi-square test.Measurement data were analyzed by t-test.The areas under ROC curve of the measurement data which had statistical significance were calculated and further Logistic regression analysis were made.Results In all of the 82 patients with first onset SLE,72 patients were in the treatment effective group and 10 were in the poor response group.Boy gender （5/10 ＆ 12/72,χ2=5.937,P=0.015）,edema （10/10 ＆ 25/72,χ2=15.294,P〈0.O1） and serositis （8/10 ＆ 25/72,χ2=7.485,P=0.006）,higher positive rate of Coombs＇ test （7/8 ＆ 14/29,x2=3.931,P=0.047） and histological class Ⅳ or Ⅳ＋Ⅴ of lupus nephritis （8/9 ＆ 6/30,χ2=14.278,P〈0.01） were more common in the poor response group.The level of hemoglobin （P=0.013）,serum albumin （P=0.001） and globulin （P=0.004）,creatinine clearance （P〈0.01）,serum calcium （P=0.040） and immunoglobulin （P=0.006） of the patients in the poor efficacy group were lower than those of patients in the treatment effective group.The level of serum potassium （P=0.011）,serum phosphorus （P=0.035）,24 hours proteinuria （P=0.001） and SLEDAI （P=0.002） of the patients in the poor response were higher than those patients in the treatment effective group.The creatinine clearance was lower than 75.91 ml·min-1· 1.73 m-2,24 hours proteinuria was higher than 1 771.5 mg and SLEDAI was higher than 11.5 could be the diagnostic cutoff value to predict the poor response to treatment in juvenile-onset SLE patients.The results of Logistic regression analysis showed creatinine clearance lower than 75.91 ml ·min-1· 1.73 m-2 was the risk factor that could influence the outcome of SLE patients （P=0.043）.The OR was 23.9 and 95%CI was from 1.10 to 516.8.Conclusion In juvenile-onset SLE patients,boys have poor response to treatment.The creatinine clearance lower than 75.91 ml·min 1· 1.73 m-2,24 hours proteinuria higher than 1 771.5 mg and SLEDAI higher than 11.5 can predict the poor response to treatment in juvenile-onset SLE patients.In addition,the SLE patients with autoimmune hemolytic anemia may have poor response to treatment.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2014年第9期627-631,共5页
Chinese Journal of Rheumatology
关键词
红斑狼疮
系统性
危险因素
儿童
Lupus erythematosus, systemic
Risk factors
Child
