切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 126 -131. doi: 10.3877/cma.j.issn.2096-1537.2021.02.006

临床研究

ICU系统性红斑狼疮患者的临床特征与预后分析
巴俊慧1, 王艳红1, 胡佳佳1, 吴本权1,()   
  1. 1. 510630 广州,中山大学附属第三医院内科ICU
  • 收稿日期:2019-12-26 出版日期:2021-05-28
  • 通信作者: 吴本权
  • 基金资助:
    广东省科技计划项目(2017A020215177)

Clinical characteristics and prognostic factors of patients with systemic lupus erythematosus in the intensive care unit

Junhui Ba1, Yanhong Wang1, Jiajia Hu1, Benquan. Wu1()   

  1. 1. Department of Medical Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
  • Received:2019-12-26 Published:2021-05-28
  • Corresponding author: Benquan. Wu
引用本文:

巴俊慧, 王艳红, 胡佳佳, 吴本权. ICU系统性红斑狼疮患者的临床特征与预后分析[J/OL]. 中华重症医学电子杂志, 2021, 07(02): 126-131.

Junhui Ba, Yanhong Wang, Jiajia Hu, Benquan. Wu. Clinical characteristics and prognostic factors of patients with systemic lupus erythematosus in the intensive care unit[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 126-131.

目的

探讨ICU系统性红斑狼疮(SLE)患者的临床特征和预后的影响因素。

方法

回顾性分析2013年1月至2019年6月入住我院内科ICU的SLE患者的临床数据,主要包括:年龄、性别、患病年限、主要器官受累情况、SLE疾病活动指数(SLEDAI)、急性生理学与慢性健康状况(APACHEⅡ)评分、ICU住院时间及转归、入住ICU的直接原因、ICU住院期间治疗(包括糖皮质激素、免疫抑制剂、大剂量免疫球蛋白、有创机械通气、血液透析、血管活性药物)以及主要的实验室检查数据。

结果

共纳入61例患者,以女性为主(68.85%),APACHEⅡ评分(18.93±7.62)分。感染和急性心力衰竭是转入ICU最常见的原因。多因素Logistic回归分析提示APACHEⅡ评分≥20分、血管活性药物应用、脓毒症与预后相关(OR=23.326,95%CI:2.307~235.896,P=0.008;OR=26.218,95%CI:1.641~418.897,P=0.021;OR=17.194,95%CI:1.332~221.945,P=0.029)。

结论

ICU的SLE患者预后较差,APACHEⅡ评分≥20分、血管活性药物应用、脓毒症是其死亡的危险因素。

Objective

To discuss the clinical features and prognostic factors in patients with systemic lupus erythematosus (SLE) in intensive care unit (ICU).

Methods

The clinical data of patients with SLE who were admitted in the medical ICU of our hospital from Jan 2013 to Jun 2019 were retrospectively analyzed. Major clinical data include age, gender, age, years of disease, major organ involvement, SLE disease activity index (SLEDAI), acute physiology and chronic health (APACHEⅡ) score, duration of ICU and hospital stay, reason of ICU admission and treatments during the ICU stay (including glucocorticoids, immunosuppressors, high dose immunoglobulin, invasive mechanical ventilation, hemodialysis, vascular active drugs), and laboratory results.

Results

A total of 61 patients were evaluated in this study. Most patients were female (68.85%), and APACHEⅡ score was(18.93±7.62). The leading causes of admission were infection and acute heart failure. Multivariable logistic regression showed that APACHEⅡ score ≥ 20 point,administration with vasopressors and sepsis (OR=23.326, 95%CI: 2.307-235.896, P=0.008; OR=26.218, 95%CI: 1.641-418.897, P=0.021; OR=17.194, 95%CI: 1.332-221.945, P=0.029) were significantly associated with mortality.

Conclusion

The outcome of SLE patients admitted in the ICU is poor. APACHEⅡ score ≥ 20 point, administration with vasopressors and sepsis are risk factors of death.

图1 ICU收治的系统性红斑狼疮患者预后分析流程图
表1 61例SLE患者的基本特征
表2 61例SLE患者入住ICU的原因统计
表3 61例SLE患者存活和死亡的单因素分析
表4 SLE患者死亡相关危险因素多因素Logistic回归分析
1
Mak A, Cheung MW, Chiew HJ, et al. Global trend of survival and damage of systemic lupus erythematosus: meta-analysis and meta-regression of observational studies from the 1950s to 2000s [J]. Semin Arthritis Rheum, 2012, 41(6): 830-839.
2
Lopez R, Davidson JE, Beeby MD, et al. Lupus disease activity and the risk of subsequent organ damage and mortality in a large lupus cohort [J]. Rheumatology (Oxford), 2012, 51(3): 491-498.
3
Williams FM, Chinn S, Hughes GR, et al. Critical illness in systemic lupus erythematosus and the antiphospholipid syndrome [J]. Ann Rheum Dis, 2002, 61(5): 414-421.
4
Siripaitoon B, Lertwises S, Uea-Areewongsa P, et al. A study of Thai patients with systemic lupus erythematosus in the medical intensive care unit: epidemiology and predictors of mortality [J]. Lupus, 2015, 24(1): 98-106.
5
Couto DO, Feijó CA, Aguiar SM, et al. Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital [J]. Rev Bras Ter Intensiva, 2008, 20(3): 249-253.
6
Namendys-Silva SA, Baltazar-Torres JA, Rivero-Sigarroa E, et al. Prognostic factors in patients with systemic lupus erythematosus admitted to the intensive care unit [J]. Lupus, 2009, 18(14): 1252-1258.
7
Hsu CL, Chen KY, Yeh PS, et al. Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study [J]. Crit Care, 2005, 9(3): R177-183.
8
Feng PH, Lin SM, Yu CT, et al. Inadequate antimicrobial treatment for nosocomial infection is a mortality risk factor for systemic lupus erythematous patients admitted to intensive care unit [J]. Am J Med Sci, 2010, 340(1): 64-68.
9
Fatemi A, Shamsaee S, Raeisi A, et al. Prognostic factors of mortality in Iranian patients with systemic lupus erythematosus admitted to intensive care unit [J]. Clin Rheumatol, 2017, 36(11): 2471-2477.
10
Suárez-Avellaneda A, Quintana JH, Aragón CC, et al. Systemic lupus erythematosus in the intensive care unit: a systematic review [J]. Lupus, 2020, 29(11): 1364-1376.
11
任昊, 许顶立. 系统性红斑狼疮合并心力衰竭研究进展 [J]. 中国实用内科杂志, 2018, 38(8): 762-765.
12
Urowitz MB, Gladman D, Ibañez D, et al. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus [J]. Arthritis Care Res (Hoboken), 2010, 62(6): 881-887.
13
Dhakal BP, Kim CH, Al-Kindi SG, et al. Heart failure in systemic lupus erythematosus [J]. Trends Cardiovasc Med, 2018, 28(3): 187-197.
14
Kim CH, Al-Kindi SG, Jandali B, et al. Incidence and risk of heart failure in systemic lupus erythematosus [J]. Heart, 2017, 103(3): 227-233.
15
Kang KY, Kwok SK, Ju JH, et al. The causes of death in Korean patients with systemic lupus erythematosus over 11 years [J]. Lupus, 2011, 20(9): 989-997.
16
侯成成, 金欧, 张曦, 等. 系统性红斑狼疮患者合并感染的临床特点及危险因素分析 [J]. 新医学, 2015, 46(11): 743-747.
17
Zamir G, Haviv-Yadid Y, Sharif K, et al. Mortality of patients with systemic lupus erythematosus admitted to the intensive care unit - A retrospective single-center study [J]. Best Pract Res Clin Rheumatol, 2018, 32(5): 701-709.
18
杨小蕾, 廖雪莲, 韩莉, 等. 重症医学科内系统性红斑狼疮合并脓毒症患者临床表现和预后分析 [J]. 四川大学学报(医学版), 2016, 47(4): 594-598.
19
董光富, 张晓, 雷云霞, 等. 重症监护病房系统性红斑狼疮患者预后因素分析 [J]. 中华风湿病学杂志, 2009, 13(7): 463-466.
20
Aragón CC, Ruiz-Ordoñez I, Quintana JH, et al. Clinical characterization, outcomes, and prognosis in patients with systemic lupus erythematosus admitted to the intensive care unit [J]. Lupus, 2020, 29(9): 1133-1139.
21
Mageau A, Sacré K, Perozziello A, et al. Septic shock among patients with systemic lupus erythematosus: Short and long-term outcome. Analysis of a French nationwide database [J]. J Infect, 2019, 78(6): 432-438.
22
Oud L. Epidemiology and outcomes of sepsis among hospitalizations with systemic lupus erythematosus admitted to the ICU: a population-based cohort study [J]. J Intensive Care, 2020, 8: 3.
23
Alzeer AH, Al-Arfaj A, Basha SJ, et al. Outcome of patients with systemic lupus erythematosus in intensive care unit [J]. Lupus, 2004, 13(7): 537-542.
24
ع الغامدي. Patterns of systemic lupus erythematosus in the intensive care unit and causes of mortality [J]. J King Abdulaziz Univ Med Sci, 2007, 14(3): 13-23.
25
Andonopoulos AP. Adult respiratory distress syndrome: an unrecognized premortem event in systemic lupus erythematosus [J]. Br J Rheumatol, 1991, 30(5): 346-348.
26
Kim WU, Kim SI, Yoo WH, et al. Adult respiratory distress syndrome in systemic lupus erythematosus: causes and prognostic factors: a single center, retrospective study [J]. Lupus, 1999, 8(7): 552-557.
27
Han BK, Bhatia R, Traisak P, et al. Clinical presentations and outcomes of systemic lupus erythematosus patients with infection admitted to the intensive care unit [J]. Lupus, 2013, 22(7): 690-696.
28
Antón JM, Castro P, Espinosa G, et al. Mortality and long term survival prognostic factors of patients with systemic autoimmune diseases admitted to an intensive care unit: a retrospective study [J]. Clin Exp Rheumatol, 2012, 30(3): 338-344.
29
Wu W, Ma J, Zhou Y, et al. Mortality risk prediction in lupus patients complicated with invasive infection in the emergency department: LUPHAS score [J]. Ther Adv Musculoskelet Dis, 2019, 11: 1759720X19885559.
[1] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[7] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[8] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[9] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[10] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[11] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[12] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[13] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要