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目的 探讨重症神经精神性狼疮 (NPLE)急性期影响预后的因素。方法 1991—1999年在中山医科大学附属第一医院住院的重症NPLE 136例。运用回顾性队列研究策略 ,以病人入院日为研究起点 ,死亡为阳性结局。研究因素包括性别 ,年龄 ,病程 ,症状 ,并发症 ,狼疮活动指数 ,各种常规、生化和免疫学检查 ,治疗措施等 5 5个变量。建立Logistic回归模型 ,计算校正前后的OR值及其 95 %CI。结果 136例NPLE病人中 31例死亡 ,占 2 2 8%。单因素分析显示 ,年龄、器质性脑病、脑血管意外 (卒中 )、肾功能不全尿毒症期、肝功能损害、心功能不全、合并感染、环磷酰胺 (CTX)冲击治疗及甲基泼尼松龙冲击治疗与NPLE的死亡有关。经逐步引入 剔除法 ,建立Logistic回归模型 ,仍然与死亡有关的因素包括脑血管意外、心功能不全、肝功能损害、尿量、CTX冲击治疗、甲基泼尼松龙冲击治疗。其中脑血管意外、心功能不全、肝功能损害和尿量减少是重症NPLE死亡的危险因素 ;CTX和甲基泼尼松龙冲击治疗是保护性因素。结论 在重症NPLE ,合并脑血管意外、心功能不全、肝功能损害和尿量减少是预后不良的危险因素 ;CTX和 /或甲基泼尼松龙冲击治疗可以减少死亡 ,改善预后。提示临床治疗重症NPLE时 ,需注意改善心功能 ,保护肝功能 ,检测尿量?
Objective To investigate the prognostic factors of acute neurileptic lupus (NPLE) in acute stage. Methods A total of 136 patients with severe NPLE were admitted to the First Affiliated Hospital of Sun Yat-sen University from 1991 to 1999. Using the retrospective cohort study strategy, taking the patient admission day as the research starting point, the death was a positive result. The study included 54 variables including gender, age, course of disease, symptoms, complications, lupus activity index, various routine, biochemical and immunological tests, and treatment measures. Logistic regression model was established to calculate the OR value before and after correction and its 95% CI. Results Thirty-one of 136 NPLE patients died, accounting for 22.8%. Univariate analysis showed that age, organic encephalopathy, cerebrovascular accident (stroke), renal insufficiency uremia, hepatic dysfunction, cardiac insufficiency, co-infection, CTX and methylprednisolone Pineel impact treatment and the death of NPLE. After gradual introduction of culling method, a Logistic regression model was established. Factors still related to death included cerebrovascular accident, cardiac insufficiency, liver damage, urine output, CTX shock therapy and methylprednisolone impact therapy. Including cerebrovascular accident, cardiac insufficiency, liver dysfunction and decreased urine output is a risk factor for severe NPLE death; CTX and methylprednisolone impact therapy is a protective factor. Conclusions Severe NPLE with cerebrovascular accident, heart failure, impaired liver function and decreased urine output are risk factors for poor prognosis. CTX and / or methylprednisolone impact therapy can reduce death and improve prognosis. Prompt clinical treatment of severe NPLE, we should pay attention to improving cardiac function, protect liver function, urine output test?