單中心回溯性研究：紅斑性狼瘡病人10年存活率及死因分析

10-year-survival rate and specific cause of death in patients with systemic lupus erythematosus: a single center retrospective study

目的：分析系統性紅斑性狼瘡病人10年存活率及死因分析。方法：在國立台灣大學醫學院附設醫院診斷紅斑性狼瘡且符合1）1997或2012或2019分類準則標準的病人；2）收錄從2010到2020的病人。從電子病歷收錄相關臨床表現及檢驗數據。以Kaplan-Meier曲線分析10年存活率，並進一步分析可能的危險因子。結果：共收錄429人，其中有19人死亡，10年存活率預測為91.1％（95％信賴區間86.1％－96.4％）。死因分析中，感染占了最大宗且以肺炎為主。死亡的這組病人，有較老的診斷年紀以及較多的狼瘡性腎炎。另外，因感染而死亡的病人，13位中有12位（92.3％）使用高於7.5mg的類固醇（平均類固醇使用劑量約為15mg）且12位中有10位（1位資料缺失）伴有較低的免疫球蛋白指數。結論：國立台灣大學附設醫院紅斑性狼瘡病人10年存活率預測為91.1％，與現行國際數據相似。其中死亡組有較老的診斷年紀及較多的狼瘡性腎炎。死因以感染佔大宗且以肺炎為主。盡可能減少長期類固醇使用劑量及定期追蹤免疫球蛋白G指標可能有助於減少病人因感染而死亡的風險。

Objective: To evaluate the 10-year-survival rate and specific cause of death in patients with systemic lupus erythematosus. Methods: This is a retrospective study in National Taiwan University Hospital, a tertiary hospital in northern Taiwan. Inclusion criteria were as follows: 1) SLE patients who met either the 1997 Revision of 1982 ACR classification criteria, the 2012 SLICC classification criteria or the 2019 EULAR/ACR classification criteria, 2) from January 2010 to December 2020. Demographic and clinical data, specific cause of death were recorded from electronic medical records. Survival would be presented via Kaplan-Meier (K-M) survival curve. Factor associated with mortality would be analyzed via Cox-regression. Results: A total of 429 patients with SLE were recruited during the study period. Among them, 19 (19 of 429, 4.4%) patients died. The 10-year-survival rate was estimated at 91.1% (95% CI, 86.1% to 96.4%). Infection is the most common cause of death (13 of 19, 68.4%) with pneumonia predominantly (11 of 13, 84.6%). Further analysis revealed positive correlation between mortality and older age at diagnosis and lupus nephritis. Among infection-related mortality, 12/13 (92.3%) patients received equivalent prednisolone of＞7.5 mg/day with an average prednisolone dosage of 15 mg and acquired low IgG levels were observed in 10 of 12 (83.3%) patients (one missing data). Conclusions: Patients with SLE in NTUH have a 10-year-survival rate of approximately 91.1%, which was comparable with the data of the other countries. Patients who were older at diagnosis and had lupus nephritis had high mortality risk. Among them, infection is the leading cause of death, with pneumonia predominance. Additionally, decreasing the prednisolone dose to＜7.5 mg per day and monitoring IgG levels regularly may help prevent infection-related mortality in patients with SLE.