【作者】 夏婕；

【导师】 吴元胜；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2012， 硕士

【摘要】 目的通过对系统性红斑狼疮住院患者的病历资料进行回顾性研究,分析其临床发病特点及中西医治疗特点,总结相关临床经验,为SLE的中西医结合规范化治疗提供借鉴和参考。方法对2006-2010年广东省中医院总院收治的系统性红斑狼疮住院患者的病历资料进行回顾性研究,分析内容包括：一般资料、首发症状、临床表现、并发症、中医舌脉证侯、中西医诊断、中西医治疗用药、疾病转归等,并对死亡病例进行分析,总结相关临床经验。结果本研究共收集病例资料292份,性别构成比为男：女=1：8.7,21～40岁患者占52.74%,一半的患者病程不到一年。63.01%的患者入院情况危急,98.29%的患者为中西医结合治疗,大部分患者病情好转出院,治疗总有效率为92.82%；6例死亡病例均合并感染或重要脏器的损害,其中1例死于自杀,1例因未及时确诊而延误治疗。平均住院费用为12350.71±14069.28元,平均住院日由2006年的19.55到2010年的14.84天,有明显下降趋势(P<0.05)。首发症状以关节痛、面部红斑、发热、浮肿为多见,入院前经诊病例误漏诊率为46.59%,97例患者入院后明确诊断。狼疮性肾炎、血细胞减少是SLE最常见的并发症,94.18%的患者于肾病科、皮肤科、血液科住院治疗；189例患者并发狼疮性肾炎,占64.73%。疲倦乏力、食欲不振、颜面或四肢浮肿、面部红斑或皮疹、关节痛或肿胀、发热、浆膜腔积液、咳嗽、头晕头痛、泡沫尿、脱发为SLE十大主要症状,治疗后以发热改善最为明显。本病病性以虚实夹杂为主,入院主证多见气阴两虚、脾肾亏虚(气虚、阳虚)、阴虚内热、肝肾阴虚型等,以前两者为主,兼证以湿、热、瘀邪为主；出院证型比例无明显改变。舌脉象依据频数排名为：红、淡暗、暗红、淡红舌；黄腻(厚)、黄(薄)、白腻(厚)、白(薄白)苔；细、弦、数、沉脉。糖皮质激素为治疗SLE的主要药物,配合免疫抑制剂、免疫球蛋白为临床常用治疗方案,血浆置换应用较少,对症以抗疟药、非甾体类抗炎药、免疫调节剂,并以中药汤剂、中成药辅助治疗；中药及中成药以益气养阴、补脾益肾,兼以清热祛湿、活血化瘀为法,清热药、补气药、滋阴药、利湿药、活血药为组方的五大主要药类。结论1.中西医结合的方法在我院被广泛应用于SLE患者的治疗中；我院在缩短SLE患者平均住院日和控制其医疗卫生费用方面所做的工作值得肯定,SLE患者的诊疗工作日渐规范化；2.SLE的诊断仍是难点,临床需采取相应措施提高诊断水平,尽量避免错失治疗时机；3.“热”是SLE发病过程中的重要特点,“清热”之法的活用是中医药治疗SLE的一个重要手段,清热药、补气药、滋阴药、利湿药、活血药为中医治疗SLE的五大主要药类；4.我院治疗SLE多采用激素+中药、激素+免疫抑制剂+中药的经典方案,一些新近治疗方法有待积极引入和尝试,或能为SLE患者带来更多选择；5.积极预防感染和延缓重要脏器损害是延续患者生命的重要一环,应注意每一位患者都应当对本病有正确的认识,并得到心理疏导；6.SLEDAI积分的规范评估和记录需要得到各科临床医生的重视；7.电子病历系统在医疗及科研工作中发挥了重要的作用,值得在各级医院推广应用。更多还原

【Abstract】 ObjectivesThrough making a retrospective study of the data of hospitalized cases with systemic lupus erythematosus (SLE), to analyze its clinical features and summarize the treatment of traditional Chinese medicine and western medicine, which is in order to improve the diagnosis and treatment level of SLE and provide some models and the reference to its combination of traditional Chinese medicine and western medicine in standard treatment.MethodsMaking a retrospective study of the data of hospitalized SLE cases which were received by the main Branch of Guangdong Provincial Hospital of TCM from2006to2010, including general dates, original symptoms, clinical manifestations, complications, the tongue, pulse condition and symptom of TCM, diagnosis, traditional Chinese and western medicine and prognosis of diseases; analyzing death cases and conclude relevant experiences.Results292cases were collected in this study, the rate of gender composition is1:8.7,52.74%of patients were aged at21to40and half of them had course less than a year.63.01%of the cases were in a critical condition when they were hospitalized,98.29%of the cases were treated with combined traditional Chinese and western medicine, most of them had been better and discharged by the hospital, the total efficient of was92.82%; all of the6death cases were in co-infections or damaged in the important organs, one of them died from suicide and another one died because he didn’t get confirmed diagnosis which leading to delays in treatment. The average hospitalization charge cost12350.71±14069.28yuan, the mean hospital stay was19.55±10.82days in2006while the2010’s was14.84±11.02days, which had showed an obvious decrease tendency (P<0.05). First symptom to arthralgia, facial redness, fever and edema were the most common, the rate of misdiagnosis before admission was46.59%and97cases were diagnosed after admission. Lupus nephropathy and cytopenia were the most common complications of SLE,94.18%of patients were treated in the Nephrology Department, Dermatological Department and Hematology Department;189cases supervened with lupus nephropathy, which accounted for64.73%. There are ten symptoms of SLE:Weary, anorexie, edema of facial or limbs, erythema or rash on face, joint pain or fever, serous cavity effusion coughing, dizziness and headache, foamy urine and alopecia. And after treatment, fever was the most obvious symptom. The main character of SLE is deficiencyexcess mixing, the main symptoms showed after admission were Qi and Yin Deficiency, deficiency of spleen and kidney(Qi deficiency and Yang deficiency), Yin deficiency heat, hepatorenal Yin deficient, etc, and the first two had a high frequency. The accompanied symptoms were damp, hot and stasis, the rate of symptoms by leaving hospital didn’t change obviously. And according to the frequency of tongue’s pulse condition it could be ranked as follows:red, short dark, dull-red and light red in tongue; yellow greasy(pachy), yellow(thin), whitish and slimy(pachy) and whitish(thin) in tongue coating; thready pulse, taut pulse, rapid pulse and deep pulse. Glucocorticoid was the main drug used to treat SLE, cooperated with immunosuppressive and immunoglobulin was the common clinical treatment, PE was little application. Antimalarial drug, non—steroidal antiinflammatory drugs and immunomodulator were used; besides, Chinese decoction and Chinese patent medicine also helped a lot. As to Chinese decoction and Chinese patent medicine, supplementing qi and nourishing yin and invigorating the spleen and tonifying kidney were the main methods, which accompanied with clearing away heat and expelling dampness and promoting blood circulation to remove blood stasis. There were five medicines:heating-clearing herbs, qi-invigorating drugs, nourishing-yin drugs, dampnesseliminating medicinal materials and blood-activating drugs, and all of them made up a component.Conclusion1. Combination of TCM and WM is widely used in the treatment of SLE in our hospital; Our hospital’s measures in shortening average hospital stay time and containing the costs of treatment are desirable, the diagnosis and treatment of SLE patients are benchmarked gradually;2. The diagnosis of SLE is still a difficulty, some actions should be took to improve the diagnostic level in clinical, and try best to avoid mistakes in treatment;3."Hot" is its important feature, clearing heat’s flexible application is the major measure in TCM treatment. Heating-clearing herbs, qi-invigorating drugs, nourishing-yin drugs, dampness eliminating medicinal materials and blood-activating drugs are the five main medicines;4. The classical treatments of SLE, hormone and TCM, or hormone, immunosuppressive and TCM, are widely used in our hospital, some new measures are under trying, which are expected to provide more choices for SLE patients;5. Positive infection prevention and the delay of important organs’damages can be the important links in extending patients’ lives, make sure that every patient has a certain aware of SLE and can get psychological counseling;6. Benchmarking assessment and record of SLEDAI integral should be taken seriously by all kinds of clinicians;7. Electronic record system plays an important role in treatment and scientific research, which should be used widely in hospitals at all levels.更多还原