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目的:探讨老年初发的系统性红斑狼疮(SLE)患者的临床特点.方法:回顾性分析云南省第一人民医院风湿免疫科2003年1月-2013年1月629例初诊为SLE住院患者的临床资料,根据发病年龄分为老年组(年龄≥60岁)及中青年组(年龄＜60岁),分析不同年龄SLE患者临床表现、免疫学指标及疾病活动之间的关系.结果:629例SLE患者中,老年组60例,中青年组569例.老年组男性比例及病死率均较高,且并发症多,两组差异均有统计学意义(P均＜0.05);而关节炎、发热、血红蛋白降低、红细胞沉降率升高及补体C4降低的发生率,抗核小体核蛋白(RNP)抗体及抗Sm抗体阳性的发生率,两组差异均无统计学意义(P均＞0.05).SLE老年组患者肌痛、肌无力、浆膜炎、心脏损害、肺脏损害、WBC降低和血小板降低的发生率均高于中青年组;而蝶形红斑、脱发、肾脏损害、雷诺现象、光敏感及补体C3降低的发生率和抗双链(ds)-DNA抗体以及抗核小体(Anu-A)抗体的阳性率均低于中青年组,差异均有统计学意义(P均＜0.05).结论:老年SLE患者与中青年相比,临床表现存在多种差异,具有轻型化及非典型化特点,但特异性较高的免疫指标阳性率较低,且病死率高,须对老年发病的SLE患者提高警惕,临床上应避免漏诊及误诊.“,”Objective:To elucidate the clinical features of systemic lupus erythematosus(SLE) initially diagnosed in the elderly.Methods:They retrospectively analyzed the clinical data of a total of 629 patients with SLE initially diagnosed and admitted to the Department of Rheumatology of their hospital from January 2003 to January 2013.Patients were divided into two groups,i.e.age ≥60(aged) and ＜60 years old(young/middle aged).The differences in clinical features,immunological indices and disease activity were compared between these two age groups.Results:The number of patients in aged and young/middle aged groups were 60 and 569 patients,respectively.The male to female ratio,mortality and complication rates were significantly higher in aged group than in young/middle aged groups(P＜0.05),while there were no dramatic differences in the incidence of fever,arthritis,extent of decreased hemoglobin level and increased erythrocyte sedimentation rate,incidence of reduction in complement C4 levels,or the positivity rate of anti-ribonucleoprotein(RNP),and positive rates of anti-Sm autoantibodies between the two groups(P＞0.05 for all).However,aged group displayed higher incidence of myalgia,myasthenia,serositis,heart and lung damages,decreased WBC and platelet counts(P＜0.05,vs.young/middle aged groups).In contrast,young/middle group exhibited higher incidence of butterfly rash,alopecia,renal damage,Raynaud\'s phenomenon,photosensitivity,decreased complement C3 level,positivity rates of anti-dsDNA and anti-nucleosome antibodies(P＜0.05,vs.aged group).Conclusions:In comparison with young/middle patients,the symptoms and signs of SLE in aged patients are mild and atypical,but with a lower positive rates of specific immunological indices and a higher mortality rate.Hence,special attention should be paid to SLE occurred in the elderly in order to avoid the misdiagnosis or missed diagnosis.