전신성 홍반성 낭창의 임상상 및 병리 조직학적 분석

Abstract

The epidermiology, diagnostic criteria, clinical manifestions, renal histopathology and clinicopath-ologic correlations in 55 cases of systemic lupus erythematosus (SLE) were analyzed. The patients studied were admitted to Keimyung University Hospital from January 1982 through December 1988. The results were as follow:

1) Of 55 cases all were female except for one. Those in the age group of 20 to 30 were 45.5%, and the mean age was 29.1±9.9 years old. 2) The percentage of positive criteria present in the 1982 revised ARA diagnostic criteria for classification of SLE revealed, among those with high percentage incidence that antinuclear antibody (ANA) was 100%, persistent proteinuria 83.6%，anti-DNA antibody 75%, malar rash 61.8%, and leukopenia 61.8%. 3) Cumulative percentage incidence of commonest clinical manifestations were arthritis & arthralgia 67.2 %’ edema 63.6%，malar rash 61.8%，fever 60%, fatigue 52.7% and alopecia 41.8%. 4) Hematologic laboratory findings were anemia 80 %，leukopenia 48%, lymphopenia 54% and thrombocytopenia 38.2%; Blood chemistries were hypo-proteinemia 40.4%, elevation of SGOT level 29.6%, elevation of SGPT level 13%, and in the immunologic laboratory findings, there was of the decreased C3 titer 79.6%, C4 titer 29.4%, reversed A/G ratio 92.3%, hyperglobulinemia 23.1%, LE cell preparation 37.7%，cryoglobulinemia 18.9%, and rheumatoid factor 17.6%. 5) Degree of daily proteinuria revealed that under 1.0 g/day was 28.6%, 1.0〜3.5g/day 26.5%, over 3.5 g/day 44.9%. Degree of renal funciton revealed that creatinine clearance over 50 ml/min was 44%, 30—50 ml/min 22%, under 30 ml/min 34%，serum creatinine under 1.7 mg/dl 73.1%, 1.7〜3.0 mg/dl 17,3%，and over 3.0 mg/dl 9.6%. 6) The prevalence of different WHO classification of biopsies 26 cases with lupus nephritis were class IIa 11. 5%, lib 26.9%, III 3.8%’ IV 46.2% and V 11.5%. 7) Relatively higher frequency of nephrotic syndrome, hypertension, renal function impairment, and hematuria were shown in class IV and V of lupus nephritis. During follow-up periods (mean 13.8士11.6 months) of the renal biopsied cases, improved renal function was found in 7 cases, 6 cases were stable, while 7 cases deteriorted and death occured in 6 cases. 8) During clinical course of the SLE, improved clinical manifestions in 47.2%, no change in 9.1%, 5.5% were worse and death occured in 20%. 9) Fatalities occurred in 11 cases of SLE. The main cause of death was infectious episodes (6 cases), while other causes of death were congestive heart failure (2 cases), subarachnoid hemorrhage, renal failure and CNS involvement (1 cases of each).