ACR：台湾国立阳明大学研究者发现系统性红斑狼疮患者蛛网膜下腔出血风险增加

系统性红斑狼疮（SLE）患者自发性蛛网膜下腔出血（SAH）相对比较常见，这一现象已被重视，但是，相关的后续研究结果存在冲突。针对这一情况，来自台湾国立阳明大学和新北市双和医院、台北医学大学的YU-SHENG CHANG等人进行了一项以全体人群为基础的研究，目的是评估SLE患者发生SAH的风险。研究结果在线发布在2013年4月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，SAH是与SLE相关的罕见并发症，但其死亡率高。除高龄外，日平均激素使用量高和红细胞、血小板输注史均与SLE患者并发SAH有关。

该研究共纳入16,967位SLE患者，受试者资料均来自于2000年至2006年的台湾全民健康保险（NHI）数据库，对照组由16,967位随机筛选的年龄、性别匹配的非SLE患者组成。研究者对两组的SAH发病率进行比较。用多变量的Cox比例风险模型来评估SLE患者并发SAH的风险因素。

研究结果如下，SLE组并发SAH的风险更高，发病率之比为4.84。，尽管SLE患者更年轻，但是并发SAH后的死亡率显著高于对非SLE的SAH患者（每一百万个全民健康保险受益者）。年龄、输血小板、输红细胞、平均每日类固醇剂量>10mg 泼尼松龙或者同等剂量等均是SLE患者新发SAH的独立风险因素。

研究证实，SAH是与SLE相关的罕见并发症，但其死亡率高。除高龄外，日平均激素使用量高和红细胞、血小板输注史均与SLE患者并发SAH有关。

与狼疮相关的拓展阅读：

• ICSLE：狼疮患者的心血管风险
• 系统性红斑狼疮合并血栓性血小板减少性紫癜的临床特点
• Int Med News：重视生物制剂对狼疮的作用
• AJHG：全基因组关联Meta分析搜寻系统性红斑狼疮易感基因
• Arthr Res & Ther：来那度胺或成为治疗皮肤红斑狼疮的有效疗法
• Lupus：血清肿瘤坏死因子-α水平与系统性红斑狼疮患者的生活质量和抑郁症状相关
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Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus: a nationwide population-based study.
OBJECTIVE
A relatively common occurrence of spontaneous subarachnoid hemorrhage (SAH) in patients with systemic lupus erythematosus (SLE) has been noted; however, the subsequent studies were conflicting. This nationwide population-based study aimed to evaluate the risk of SAH in patients with SLE.
METHODS
We identified 16,967 SLE patients from the Taiwan National Health Insurance (NHI) database between 2000 and 2006, and compared the incidence rate of SAH with 16,967 randomly selected age- and sex-matched non-SLE subjects. A Cox multivariable proportional hazards model was used to evaluate the risk factors of SAH in the SLE cohort.
RESULTS
The SLE cohort had a higher risk of SAH, with an incidence rate ratio of 4.84 (P < 0.001). Despite a younger age, the mortality rate after SAH was significantly higher in the SLE cohort compared to all of the non-SLE SAH patients identified from the 1 million NHI beneficiaries (60.0% versus 38.9%; P = 0.007). Age (hazard ratio [HR] 1.03, 95% confidence interval [95% CI] 1.01-1.05), platelet transfusion (HR 2.75, 95% CI 1.46-5.17), red blood cell transfusion (HR 7.11, 95% CI 2.81-17.97), and a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95% CI 2.19-8.68) were independent risk factors for the new onset of SAH.
CONCLUSION
This study demonstrated that SAH is a rare but associated complication of SLE with a high mortality rate. Other than age, higher mean daily steroid use and a history of platelet or red blood cell transfusion were associated with the occurrence of SAH in patients with SLE.