A Study Of The Gender Differences In Clinical Characteristics Of 547 Patients With Systemic Lupus Erythematosus

Systemic Lupus Erythematosus?SLE?,as a rheumatic immune disease,has its unique disease characteristics.It affects a wide range of organs and has great difficulty in diagnosis,which fully confirms its complexity and uncertainty.Women are more vulnerable to SLE.With the rather small proportion of male SLE patients and atypical clinical manifestations,there is a strong possibility for us to draw a wrong diagnosis and even miss the diagnosis,which do exert a negative influence on the early diagnosis and early treatment,as well as the prognosis of SLEObjectives:By studying the gender differences of the clinical characteristics of SLE,we emphasize the importance of sexually stratification in the diagnosis of the disease,which will contribute to promote the accuracy of diagnosis of male patients,and be helpful to the early diagnosis,early treatment and improvement of prognosis,as well as be beneficial to form a deeper understanding of the differential clinical characteristics of'SLE,aiming to provide a continuous impetus for the personalized therapeutic treatments of SLE.Methods:In this study,547 male and female patients of SLE diagnosed by ACR?American College of Rheumatology?1997 recommended criteria were enrolled,with their data being collected,to compare the gender differences of male and female SLE patients,further to analyze and summarize the differential clinical manifestations of male patients.Results:Out of the 547 patients,aged from 6 to 81 years old,154?28.2%?were males and 393?71.85%?were females,with the mean age of 31.10± 14.09 years and the average diagnosis age of 32.19±14.58 years.The male patients,aged from 6 to 73 years old,with the mean age of 30.10±5.37 years and the average age of 32.12±15.84 years,comparing to the females,aged from 7 to 81 years old,with the mean age of 31.21±13.58 years and the average age of 32.22±14.07 years,showed no statistical significance?P>0.05?both in the mean age and the average diagnosis age.Among the 547 patients,83?15.17%?were diagnosed within the first month,including 35?22.73%?males and 48?12.21%?females,with the duration between onset and diagnosis varying from 5 days to 30 years,displayed a statistically significant difference??² =9.502,P<0.05?.In the aspect of the initial symptom,the male and female manifested by fever,renal damage,arthralgia,fatigue,Raynaud phenomenon,all showed statistically significant differences?x2?10.512,P<0.05?,?X2=7.106,P<0.05?,??²?10.612,P<0.05?,??²=5.908,P<0.05?,??²=5.502,P<0.05?.In the aspect of the first diagnosis,100 male patients were misdiagnosed,with a misdiagnosis rate of 64.94%,compared with 170 misdiagnosed females,with a misdiagnosis rate of 43.26%,showing a higher misdiagnosis rate than that of the female,which displayed a statistical significance??²=20.802,P<0.05?.Male patients misdiagnosed as other CTDs?connective tissue diseases?,dermatitis,infective diseases,renal diseases,when compared with those of female patients,showed statistically significant differences??² =5.171,P<0.05?,??=21₁58,P<0.05?,?x2=7.452,P<0.05?,??²=20.564,P<0.05?.Rash,as the initial symptom,had the highest accuracy of the initial diagnosis?69.93%?and was mostly prone to be misdiagnosed as dermatitis,while fever,as the first symptom,with the lowest accuracy of the initial diagnosis?27.45%?and was mostly misdiagnosed as infectious diseases.In the aspect of symptoms,there are 67?43.51%?male patients manifested renal impairment initially and 18 undergone renal biopsy,of which 10?55.56%?manifested as type IV LN?Lupus nephritis?,comparing to 89?22.65%?of the female patients with renal impairment initially and 27 undergone renal biopsy,of which 11?40.74%?showed type IV LN,both of which displayed statistically significant differences?x2 =23.618,P<0.05?,??²=4.091,P<0.05?.2?1.30%?cases of males and 22?5.60%?of females showed HA?hemolytic anemia?,while 19?34.55%?cases of-males and 87?53.37%?of females showed moderate anemia,both of which had statistically significant differences??²=4.875,P<0.05?,??²=6.801,P<0.05?.There were 52 males?33.99%?and 185 females?44.56%?with arthritis,and 22?42.31%?males and 107 females?57.84%?with the interphalangeal joints involved,showing statistically significant differences??²=8.219,P<0.05?,??²=3.947,P<0.05?.There were 92?59.74%?males and 182?46.31%?females showed fever,46 males?29.87%?and 84?21.37%?females showed pleuritis,28?18.18%?males and 114?29.00%?females showed alopecia,as well as 13?8.44%?males and 69?17.56%?females showed Raynaud phenomenon,all of which displayed statistically significant differences??² =7.982,P<0.05?,??² =4.408,P<0.05?,??²=6.746,P<0.05?,??²=7.215,P<0.05?.In the aspect of immunological indicators,there were 108?70.13%?males and 209?53.18%?females showed positive results of anti-double stranded DNA?dsDNA?antibody,62?40.26%?males and 203?51.65%?females showed positive results of anti-SSA antibody,19?12.34%?males and 22?5.60%?females showed positive results of aCL?anti-cardiolipim antibody?,4?2.60%?males and 30?7.63%?females showed positive results of anti-?2 glycoproteinl??2 GP1?,111?80.43%?males and 270?71.05%?females showed decreased levels of C3?complement C3?,all of which showed statistically significance??²=13.044,P<0.05?,??² =5.751,P<0.05?,??²=7.248,P<0.05?,?x2 =4.814,P<0.05?,??² =4.581,P<0.05?.In the aspect of systemic lupus erythematosus disease activity index?SLEDAI?,the mean score of SLEDAI in male patients was 20.97+9.81,while the mean value of female was 18.54±9.85,showing a statistically significance?t=2.598,P<0.05?.111?72.08%?male and 246?62.60%?females patients bore severe activities of SLEDAI,showing a statistically significant difference??² =4.389,P<0.05?.Conclusion:?1?Clinical manifestations:SLE predisposes to women,with the average age and the average diagnosis age of male and female showing no significant difference,but more males tend to be diagnosed within the first month after the onset when compared with females.Males manifest fever,renal damage as the initial symptoms are more than females,while males show arthralgia,fatigue,Raynaud phenomenon are less than females.Fever,as the first symptom,has the lowest accuracy of initial diagnosis,while rash,has the lowest misdiagnosis rate.Males are more prone to show a renal damage initially,and are more likely to have a biopsy results of type IV LN than females.Males are more likely to manifest hemolytic anemia and moderate anemia than females,but show a lower possibility to manifest arthritis or the involvement of interphalangeal joints.Males are more likely to manifest fever and pleuritis,while less likely to manifest alopecia and Raynaud phenomenon.?2?Immunological indicators:Males manifest with positive results of anti-dsDNA antibody and aCL,decreased level of C3 are more than females,while show positive results of anti-SSA and anti-? 2GP1 are less than females.?3?SLEDAI:Males are more likely to display a higher disease activity,with a higher mean SLEDAI score as well as proportion of severe disease activity.