Razlike među spolovima u kliničkim manifestacijama i komorbiditetima oboljelih od sustavnog eritemskog lupusa: iskustva jednog centra

Daniela Marasović Krstulović, Leona Žuvan, Dijana Perković, Dušanka Martinović Kaliterna

Aim: The aim of this study was to determine gender differences in the clinical manifestations and comorbidities in SLE patients treated at the University Hospital of Split during a ten-year period. Methods: The medical records of patients diagnosed with SLE were collected from the Outpatient Clinics, ward, and Day Hospital of the Department of Rheumatology and Clinical Immunology of the University Hospital of Split. All SLE manifestations and comorbidities were recorded. The SPSS 25 (IBM, New York, USA) package was used for statistical analysis. Assessment of the differences between the genders was performed by χ2 test, univariate logistic
regression, and multivariate logistic regression. Results: The study included 268 SLE patients, 242 (90%) females and 26 (10%) males, aged 22-88 years (median 52; Q1-Q3: 41-62.75 y). In univariate regression analysis significant association was obtained between Sjögren syndrome (SS) and associated neoplasms and the female gender, while antiphospholipid syndrome (APS) and vasculitis were associated with the male gender. In multivariate logistic regression with age and gender as independent variables, a significantly higher frequency of SS (P = 0.04) and associated neoplasms (P = 0.004) were found in females, while vasculitis (P = 0.014) and APS (P = 0.003) were more frequent in males. Significant association was found between younger age and skin changes and lupus nephritis in both genders. In older patients, a significant correlation was found for dyslipidemia, hypertension, osteoporosis, gastritis, and heart involvement. Conclusion: In our study of SLE patients, SS and associated neoplasms were more common in women, whereas
in men vasculitis and APS were more frequent. Lupus nephritis and skin changes occured more frequently in patients of younger age in both genders. In elderly patients, dyslipidemia, hypertension, heart involvement, osteoporosis, and gastritis were more likely to occur. For a better understanding of this problem it is necessary to examine a larger population of patients and monitor it over time.

Cilj: Cilj je ovog istraživanja bio ispitati razlike u kliničkim manifestacijama i komorbiditetima između muškaraca i žena oboljelih od SLE -a i liječenih u KBC -u Split. Ispitanici i metode: Podatci bolesnika koji su imali dijagnozu SLE -a u razdoblju od 1. 1. 2007. godine do 31. 12. 2016. prikupljeni su iz ambulanta, stacionara i dnevne bolnice Zavoda za reumatologiju i kliničku imunologiju Klinike za unutarnje bolesti Kliničkoga bolničkog centra Split. Analizirani su sve zabilježene kliničke manifestacije i pridruženi komorbiditeti. Za statističku je analizu upotrijebljen paket SPSS 25 (IBM, New York, SAD). Služili smo se χ2-testom te univarijatnom i multivarijatnom logističkom regresijom. Rezultati: Istraživanje je obuhvatilo 268 bolesnika s dijagnozom SLE -a: 26 muškaraca (10%) i 242 žene (90%). Medijan dobi ispitanika iznosio je 52 godine (min. – maks.: 22 – 88 god.; Q1 – Q3: 41 – 62,75 god.). χ2-testom utvrdili smo da je ženski spol bio znatno povezan sa Sjögrenovim sindromom (SS) i pridruženim neoplazmama, a antifosfolipidni sindrom (APS) i vaskulitis bili su povezani s muškim spolom. S obzirom na medijan dobi svoje smo ispitanike podijelili u tri skupine. Multivarijatnom logističkom regresijom u kojoj su neovisne varijable bile dob i spol dobili smo statistički značajnu povezanost SS-a (P = 0,04) i pridruženih neoplazma (P = 0,004) sa ženskim spolom, dok su u muškaraca učestaliji bili vaskulitis (P = 0,014) i APS (P = 0,03). Zaključak: Prema našem istraživanju bolesnika sa SLE -om, u žena su bili učestaliji SS i pridružene neoplazme, a u muškaraca vaskulitis i APS. Lupus nefritis i kožne promjene češće se javljaju u bolesnika mlađe dobi u oba spola. Kod starijih su bolesnika češći dislipidemija, hipertenzija, zahvaćenost srca, osteoporoza i gastritis. Radi jasnijeg objašnjenja ovog problema potrebno je istražiti puno veću populaciju bolesnika te ih pratiti dulje razdoblje.