0.05);在性別上兩組具有相關性 (p<0.001)。利用邏輯斯迴歸分析發現死亡率與ESR(每增加1個單位,SLE病人死亡率增加1.011倍) 、APACHⅡ、CRP、Cre等因子有關係,與IgG則無關係(p=0.431)。 結論: 肺部疾病是SLE病人進入加護病房最大原因(48.4%);死亡率在兩組的比較並無顯著差異(p=0.483)。IgG與ESR對於重症的SLE病人進入ICU各方面關聯性及比較可以發現:會被ESR影響的變項因子比IgG多,但並非意謂IgG不重要,而原因可能是收案數僅限於單一醫學中心且收案條件是第一次進入加護病房的病人,母群體數只有126名,也許影響到對照組與實驗組在死亡率、生化檢驗、呼吸器的使用、APACHⅡ及SLEDAI等等結果。IgG及ESR並非是SLE病人特異性發炎因子,應有其他隱含因子或是在加護病房受到抗藥性菌株感染影響,其間複雜的機制,需待進一步的研究。' /> 重症紅斑性狼瘡病人血清IgG與ESR對其預後之關連性研究 = The association of serum IgG and ESR in prognosis for patients with critical SLE|Airiti Library 華藝線上圖書館
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  • 學位論文

重症紅斑性狼瘡病人血清IgG與ESR對其預後之關連性研究

The association of serum IgG and ESR in prognosis for patients with critical SLE

指導教授 : 曾博修

摘要


背景:已知紅斑性狼瘡(Systemic lupus erythematosus,SLE)是一複雜的自體免疫疾病,人體很多器官會受其影響導致正常功能無法運作,組織慢性發炎過程形成多變的預後不確定性。在台灣,依據衛生福利部統計處公佈:民國100年全民健康保險醫療統計20歲以上,SLE的盛行率是每10萬人門診有14121人。 SLE常用系統性紅斑性狼瘡國際臨床合作組/美國風濕病學會(Systemic Lupus International Collaborating(SLICC)/American College of Rheumatology(ACR) Damage Index或SLEDAI(SLE Disease Activity Index)的評估方法來表示疾病嚴重及器官損傷程度,是很有力的預測及預後方法,但追蹤時間長,評估面項過於複雜。最近的研究已經指出:SLE釋放的發炎因子(例如IgG、ESR、CRP等)是扮演疾病病程及在加護病房的結果重要角色。本文研究主要是探討發炎因子IgG及ESR對重症紅斑性狼瘡病人各方面影響以及關聯性。 方法:本研究針對2008年至2012年進入某中區醫學中心加護病房(ICU)的重症紅斑性狼瘡病人共計448位,經排除各種情形後收案共計126名。以發炎因子-IgG及ESR濃度高低進行分組(對照組與實驗組),然後再以IgG濃度高低分為3組;同樣的也以ESR濃度分為2組。以上各組分別與病人之檢驗值數據(生化、全血計數、白血球分類計數等)、病人進入加護病房的病因及治療日數;嚴重程度分數(APACHⅡ)、使用呼吸器天數及紅斑性狼瘡疾病活動度評分(SLEDAI)相互比較。統計方式以SPSS(Statistical Package for Social Science) 12.0版統計套裝軟體來分析統計。所使用之統計方法包含:學生T檢定(Student's t test)、皮爾森卡方檢定(Pearson's Chi-square test)或是費雪精確檢定(Fisher's exact test)、K-W檢定(Kruskal-Wallis Test)或Jonckheere-Terpstra檢定、邏輯斯迴歸分析(logistic regression),本研究死亡統計分析採取單變數邏輯斯迴歸分析(univariate logistic regression)或多變數邏輯斯迴歸分析(multiple logistic regression)。以上統計分析方法可以了解重症紅斑性狼瘡病人之IgG及ESR濃度高低與其疾病嚴重度,實驗室檢驗值、加護病房治療天數與呼吸器使用等結果之間相互關係,或許可以加強在加護病房工作的醫護人員對於此類重症病人的照護及適當處置。 結果:經分組(對照組:IgG及ESR濃度在參考值內;實驗組:IgG及ESR任一濃度超過參考值)後,以Student's t test分析發現:兩組在年齡、生化中的Cholesterol、TG、CRP、CRE有相關性(p<0.05)。以Pearson's Chi-square test分析發現兩組死亡率、呼吸器(侵襲性或非侵襲性)的使用沒有相關性(p>0.05);在性別上兩組具有相關性 (p<0.001)。利用邏輯斯迴歸分析發現死亡率與ESR(每增加1個單位,SLE病人死亡率增加1.011倍) 、APACHⅡ、CRP、Cre等因子有關係,與IgG則無關係(p=0.431)。 結論: 肺部疾病是SLE病人進入加護病房最大原因(48.4%);死亡率在兩組的比較並無顯著差異(p=0.483)。IgG與ESR對於重症的SLE病人進入ICU各方面關聯性及比較可以發現:會被ESR影響的變項因子比IgG多,但並非意謂IgG不重要,而原因可能是收案數僅限於單一醫學中心且收案條件是第一次進入加護病房的病人,母群體數只有126名,也許影響到對照組與實驗組在死亡率、生化檢驗、呼吸器的使用、APACHⅡ及SLEDAI等等結果。IgG及ESR並非是SLE病人特異性發炎因子,應有其他隱含因子或是在加護病房受到抗藥性菌株感染影響,其間複雜的機制,需待進一步的研究。

並列摘要


Background: Have already known the SLE(Systemic lupus erythematosus) can bring chronic inflammation influence to mankind's physiology the whole organ system. What it was a very typical autoimmune disease, included to change more prepares behind indetermination. In Taiwan, announce according to the health welfare department. Department of Statistics: National health insurance medical treatment statisticses in Year 100 of the Republic of China 20 years old above become adult SLE prevalence is each 100,000 people's out-patient service to contain 14121 people. SLE in common use system erythema the lupus is international clinical cooperation set of/American rheumatism learn of valuation method to indicate the disease severity and organ harm degree. Although still predicting and preparing a rear method very strongly now, must tracking time is long, too slow to be of help in a crisis. The last few years of research has been already pointed out: The inflammation factor(for example CRP, ESR, and IgG...etc.) that SLE produces is playing the course of illness of disease and patient to get into an intensive care unit result important role, this text research is mainly to inquire into inflammation factor IgG and ESR face the influence on patient's everyone of advanced case SLE. Methods: This research aims at to get into for 2008-2012 years certain win the advanced case SLE of the intensive care unit in the area medical center .The patient add up to 448 and after expeling a variety of situations, accept a case to add up to 126.The set(Control Group and Experimental Group) that carries on the cent by the inflammation factor-IgG and the ESR density height then is divided into 3 sets by IgG density height; The same are also divided into 2 sets by ESR density. The examination value data(bio-chemical, the whole bloodses count, the leukocyte classification count etc.), patient of above each difference and patient gets into cause of disease and treatment of intensive care unit day count; The serious degree score(APACH II), the use breather number and the SLE disease movable degree grade point(SLEDAI) compares mutually. Statistics the way of the software package by SPSS(Statistical Package for Social Science)12.0 versions to analytical statistics. Use of statistical method containment: Student's t test, Pearson's Chi-square test or Fisher's exact test, the Kruskal-Wallis Test or Jonckheere-Terpstra test, Logistic regression analyze, this research death statistics analysis adopts the single variable (univariate logistic regression) or change more. Conclusion: Lungs disease is occupies two group of patients to enter the intensive care unit maximum proportion (48.4%); Mortality rate in two groups of comparisons and not remarkable difference (P=0.483).IgG and ESR enter the ICU various aspects relatedness and the comparison regarding the critically ill SLE patients may discover: Can the factor be in disguised form more than by the ESR influence IgG, but signifies IgG not to be unimportant by no means, but the reason possibly is accepts a case the number only to be restricted in the sole medicine center also to accept a case the patient who the condition is first time enters the intensive care unit, perhaps the female community number only then 126, affect the control group and the experimental group in the mortality rate, the biochemistry examination, the respirator use, APACH II And SLEDAI index and so on results.IgG and ESR are by no means the SLE patient's specificity inflammation factors, should have other concealment factor perhaps the patient comes under the antibiotic strain infection influence in the intensive care unit, therefore during the complex mechanism, must treat the further research.

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