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男性系统性红斑狼疮患者发生心血管疾病更多

原标题:男性系统性红斑狼疮患者发生心血管疾病更多

摘要:背景:

本研究的目的是描述男性患者系统性红斑狼疮(SLE)的人口统计学,临床和免疫学表现。

方法:

在西班牙风湿病学会SLE登记(RELESSER)中,对3651名诊断为SLE的患者(353名男性,9.7%和3298名妇女,90.2%)进行了横断面多中心研究。

结果:

所有纳入患者的发病年龄为(18-92)岁,其中男性狼疮患者症状发作的平均年龄为37(SD 17)岁,女性为32(SD 14)岁。男/女比例为1/9。男性的症状发生年龄和诊断年龄高于女性(p <0.001)。男性较女性更易早期诊断(p = 0.04),并且心血管并发症更多见(p <0.001)。236名男性(68%)SLE患者需要住院治疗,而女性为1713名(53%)(p <0.001)。随访期间,208例患者死亡:30例为男性(9.3%),178例为女性(5.9%)(p = 0.02)。关于临床表现,在男性患者中更常见的是体重减轻(p = 0.01),淋巴结病(p = 0.02)和脾肿大(p = 0.02)。女性患者更可能患有炎性皮疹,脱发和关节炎(p <0.05)。对于肺部症状,SLE男性患者更易出现胸膜纤维化(p <0.001)和肺栓塞(p = 0.01)。然而,雷诺现象在女性(35%)比男性(23.7%)更常见(p <0.001);狼疮性肾炎在男性中更常见,存在于155(44.8%)的男性SLE患者,和933(29%)的女性SLE患者(p <0.001)。多变量分析显示,Charlson指数(超过3分)和年龄> 50岁的SLE患者死亡率更高(OR分别为3.6 和 2.1,)。此外,存在肺出血,肺动脉高压,精神症状,补体缺乏和噬血细胞综合征的SLE患者也具有更高的死亡率,无论性别如何。

结论:

年龄超过50岁的SLE患者死亡风险增加。在高加索人种中,男性诊断SLE和症状发作的年龄高于女性。男性更易被早期诊断。男性SLE患者比女性呈现更多的心血管并发症,并且出现浆膜炎,腺体疾病,脾肿大,肾脏受累,惊厥,血栓形成和狼疮抗凝物阳性亦高于女性。

附原文:

Abstract OBJECTIVE: The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients.

METHODS: A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER).

RESULTS: Mean ages (18-92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women (p < 0.001). Males were diagnosed earlier than females (p = 0.04) and had more cardiovascular comorbidities (p < 0.001). Two hundred and thirty-six males (68%) with SLE required hospitalization in comparison with 1713 females (53%) (p < 0.001). During follow-up, 208 patients died: 30 men (9.3%) and 178 women (5.9%) (p = 0.02). As regards clinical manifestations, loss of weight (p = 0.01), lymphadenopathies (p = 0.02), and splenomegaly (p = 0.02) were more common in male patients. Female patients were more likely to have inflammatory rash, alopecia, and arthritis (p < 0.05). As for lung involvement, men with SLE had more pleural fibrosis (p < 0.001) and pulmonary embolism (p = 0.01). However, Raynaud's phenomenon was more common in women (35%) than in men (23.7%) (p < 0.001); lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females (p < 0.001). Multivariate analysis showed that SLE patients with a high Charlson index (more than 3 points) and age > 50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender.

CONCLUSION: Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.

引自:

Riveros Frutos A, Casas I, Rúa-Figueroa I,Et al. Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort. Lupus. 2016 Oct 31. pii: 0961203316673728.

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文章来源:中国风湿病公众论坛

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声明:本文由入驻搜狐号的作者撰写,除搜狐官方账号外,观点仅代表作者本人,不代表搜狐立场。
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