【摘 要】 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55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22.8%。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，检测尿量及防止水钠潴留。选择适当时机，果断运用CTX和/或甲基泼尼松龙冲击治疗。Prognostic factors for severe neuropsychiatric lupus
LIANG Liuqin YANG Xiuyan LIANG Jianzhong
（Department of Rheumatology and Clinical Immunology,Affiliated First Hospital,Sun Yat-sen University of Medical Sciences,Guangzhou 510080,China）
【Abstract】 Objective To explore the prognostic factors for severe neuropsychiatric lupus (NPLE).Methods A retrospective cohort study was employed.All 136 patients who were diagnosed as severe NPLE from 1991 to 1999 in the University Hospital were included.There were 55 variables in clinical and laboratory data as the research factors and death as the outcome factor.The data were analyzed with the logistic regression model.Results Of 136 patients 31 died (22.8%).Variables in the univariate analysis those were significantly associated with death from NPLE were age,organic brain syndrome,stroke,urinemia,liver dysfunction,heart inefficiency,infection,cyclophosphamide (CTX) therapy and pulse methylprednisolone (MP) therapy.In the Logistic regression model,the variables significantly associated with death were stroke (OR＝51.22，95%CI＝3.49－751.36)，heart inefficiency (OR＝23.59，95%CI＝3.15－176.49),liver dysfunction (OR＝5.83，95%CI＝1.37－24.87)，urine volume (OR＝0.15，95%CI＝0.03－0.63)，CTX therapy (OR＝0.08，95%CI＝0.01－0.76 in low dose and OR＝0.04，95%CI＝0.004－0.37 i
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