紅斑性狼瘡相關的漿膜炎盛行率，預後因子及存活分析性

Prevalence, prognostic factors, and survival analysis of systemic lupus erythematosus-related serositis

背景：本研究主要是分析紅斑性狼瘡及其相關的漿膜炎之盛行率，預後因子及後續的存活分析。方法：本研究共納入了自2005年至2011年於林口長庚醫院風濕過敏免疫科住院及後續門診追蹤至2014年6月的609名紅斑性狼瘡病人做回溯性研究及分析。結果：609名紅斑性狼瘡住院病人，544名女性（89%）、65名男性（11%），平均發病年齡及住院年齡及分別為35.8 ± 16.5歲and40.3 ± 16.0歲。其中234名病人（38%）有漿膜炎產生（包含肋膜炎及心包膜炎），多變數迴歸分析發現血小板低下、淋巴球低下、蛋白尿及住院年齡大於50歲和狼瘡相關的漿膜炎有關。609名紅斑性狼瘡病人在追蹤期間中，94名病患死亡（15.4%）。多變數存活分析也發現住院年齡大於50歲（風險比：3.10）、血小板低下（風險比：3.23）、漿膜炎（風險比：3.03）、癲癇（風險比：2.13）、白血球低下（風險比：1.78）有較差的預後。結論：紅斑性狼瘡合併漿膜炎並不少見，本次回溯性研究也發現狼瘡病患合併漿膜炎有較差的預後。因此臨床上定期追蹤是有必要的。

Objective: To investigate the risk factors associated with systemic lupus erythematosus (SLE)-related serositis and its long-term outcome in Chinese patients. Method: Medical records of 609 hospitalized SLE patients who were followed up in Chang Gung Medical Center in Taiwan from 2005 to 2011 were retrospectively reviewed. Results: All 609 patients (89% women) who were fulfilled at least 4 of the ACR criteria for SLE and were included in the study. The mean ages at onset and at admission were 35.8 ± 16.5 years and 40.3 ± 16.0 years, respectively. Two hundred and thirty four patients (38%) had SLE-related serositis. 111 (18%) had pericarditis, 202 (33%) had pleuritis. 79 (13%) had concomitant pleuritis and pericarditis. Multivariate analysis indicated that the admission ages, proteinuria, thrombocytopenia, and lymphopenia, were independent predictors of serositis. Of the 609 SLE patients, 94 patients (15.4%) died during the study period. Of the 94 mortality cases, 63 patients had serositis. Multivariate Cox regression analysis indicated that the independent predictors of mortality were age > 50 years at admission (Hazard ratio(HR) 3.10, p < 0.001), thrombocytopenia (HR 3.23, p < 0.001), serositis (HR 3.03, p < 0.001), seizure (HR 2.13, p = 0.007) and leukopenia (HR 1.78, p = 0.041). Conclusion: This study underlines the prevalence and outcome of serositis in SLE, which is significant related to survival rates of patients. Survival was significantly lower in patients with serositis than in patients without serositis. Close follow up of SLE patients with serositis may be necessary.