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Systemic Lupus Erythematosus (SLE)

With the incidence of systemic lupus erythematosus (SLE) increasing, anesthesiologists are more likely to be exposed to patients with the disease. Next weeks we'll be discussing various aspects of SLE, and This week, we'll be discussing the incidence and prognosis of SLE.

1.  What is the incidence of SLE?
2.  What is the prognosis of SLE?
3.  What is responsible for mortality from SLE?
4.  Does the incidence of SLE increase or decrease during pregnancy?

系统性红斑狼疮（SLE）

随着系统性红斑狼疮发生率的提高，麻醉科医生也越来越多地遇到此类疾患。未来的几周我们讨论SLE的有关问题，本周我们讨论SLE的发生及诊断。

1、  SLE的发生率？
2、  SLE的预后？
3、  SLE死亡的主要原因？
4、  怀孕期间SLE的发生率增加还是降低？

参考答案：

1、  SLE的发生率？

SLE的发病率近来呈增加趋势。部分原因是因为人们对该病的认识和诊断能力提高了。然而，这也是因为该病的治疗得到了改善。曾经被认为是一种高死亡率疾患，现在SLE被认为是一种慢性疾患。最近的综述[1，2]表明，在特定的种族人群（特别是非洲人）和女性（85%）中，SLE的发病率较高，为每10万人中40-124例。

2、  SLE的预后?

如上所述，过去40年中SLE的死亡率明显下降。在1954年，4年存活率为50%；而今天超过了97%[1]。在欧洲、加拿大、美洲人的10年生存率达到了75-85%[3]。但是亚洲和非洲人的10年生存率仅为60-70%[4]。这种预后显著的差异主要在于对该病的治疗存在差别。

3、  SLE死亡的主要原因？

SLE早期的死亡主要是因为心血管相关事件，包括心梗、血栓[2]。感染在SLE死亡的各阶段中发挥重要的作用。评估SLE死亡率的多变量模型发现，有肾脏损伤的患者风险性很高，可发生血小板减少、活动性疾患表现和肺损伤[5]。

4、  怀孕期间SLE的发生率增加还是降低？

怀孕期间和产后，SLE趋于加重，但大多数症状轻微，特别是那些控制良好的患者[6]。SLE，特别是伴有抗磷脂综合征时，被认为是一种怀孕期并发症（包括流产、胎儿死亡、先兆子痫）独立的危险因素[7]。SLE患者怀孕期间血栓的危险性增高。

What is the incidence of SLE?

The incidence and prevalence of SLE appears to be increasing. In part, this stems from a better understanding of and an improved ability to diagnose the disease, however, it also results from improved treatment of the disease. Once a disease with high mortality, SLE is now considered a chronic disease. Recent reviews (1, 2) suggest that the prevalence of SLE is 40-124 per 100,000 with a higher incidence in certain ethnic groups (particularly individuals of African decent) and the female gender (85%).

What is the prognosis of SLE?

As alluded to above, a significant reduction in mortality has been noted over the past 4 decades. In 1954, survival after 4 years was 50%; today it is more than 97% (1). Moreover, the 10 year survival rate in European, Canadian, and American populations averages 75-85% (3). Asian and African populations, however, are not so fortunate, with 10 year survival rates 60-70% (4). These differences highlight the role medical therapy has on the prognosis of SLE.

What is responsible for mortality from SLE?

Early deaths from SLE are usually related to cardiovascular events including myocardial infarction and thrombosis (2). Infection also represents an important cause of mortality during all stages of SLE. Multivariate models evaluating mortality from SLE have identified patients with renal involvement and damage as having the highest risk, followed by thrombocytopenia, active disease presentation and lung involvement (5).

Does the incidence of SLE increase or decrease during pregnancy?

SLE does tend to be exacerbated during pregnancy and the puerperium, however, most flares are mild, especially in patients with well controlled disease (6). SLE, especially forms associated with antiphospholipid syndrome, has been noted to be an independent risk factor for pregnancy complications including miscarriage, fetal death, and pre-eclampsia (7). The risk of thrombosis is accentuated in SLE during pregnancy.

References:

1.  http://www.rheumatology.org/patients/factsheet/sle.html
2.  Ruiz-Irastorza G, Khamashta MA, Castellino G, Hughes GR. Systemic lupus erythematosus. Lancet. 2001;357(9261):1027-32.
3.  Uramoto KM, Michet CJ Jr, Thumboo J, et al. Trends in the incidence and mortality of systemic lupus erythematosus, 1950-1992. Arthritis Rheum. 1999;42(1):46-50.
4.  Xie SK, Feng SF, Fu H. Long term follow-up of patients with systemic lupus erythematosus. J Dermatol. 1998;25(6):367-73.
5.  Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality. J Rheumatol. 1995;22(7):1265-70.
6.  Ruiz-Irastorza G, Khamashta MA, Hughes GR. Systemic lupus erythematosus and antiphospholipid syndrome during pregnancy: maternal and fetal complications and their management. Isr Med Assoc J. 2000;2(6):462-9.
7.  Welsch S, Branch DW. Antiphospholipid syndrome in pregnancy. Obstetric concerns and treatment. Rheum Dis Clin North Am. 1997;23(1):71-84.


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