The Clinical Study Of Severe Systemic Lupus Erythematosus With Chinese Medicine And Western Medicine

ObjectiveBy analyzing the clinical data of hospitalized patients with severe systemic lupus erythematosus(SSLE),we expect to provide some reference and basis for improving the clinical diagnosis and treatment level of SSLE and improving the prognosis of patients.MethodsData of SSLE in-patients in Guangdong provincial hospital of Chinese medicine from January 2011 to December 2017 were studied retrospectively.The general information,initial symptoms,clinical mani festations,tongue pictures and pulse conditions of Chinese medicine,diagnosis and treatments of Chinese and western medicine,disease outcomes and other contents were col lected and classified.SPSS23.0 software was applied for statistical analysis.Results1.A total of 349 SSLE patients are included,with a male to female ratio of 1:5.35.The age of onset is mainly between 15 and 35 years old.The median hospital stay is 14 days,and the median hospitalization cost is 19053.83 yuan.The first symptoms usually expressed as facial and lower limb edema,joint swel ling and pain,facial erythema,fever,symptoms of urinary system,fatigue,symptoms of cardiovascular system,foam urine,symptoms of digestive system,symptoms of nervous system,etc.Clinical symptoms mainly expressed as fatigue,symptoms of urinary system,facial and lower limb edema,symptoms of cardiovscular system,dry mouth and/or dry eyes,symptoms of digest ive system,symptoms of nervous system,etc.The pre-hospital misdiagnosis rate i s 56.16%,most of which are mi sdiagnosed as diseases including the urinary system,other autoimmune diseases,blood system d iseases,respiratory system diseases,digestive system diseases,etc.Kidney,nervous sys t em and blood system are the main damaged organs(systems).IV and V are the main renal pathology classification type among lupus nephritis patients(78.08%).Patients with strong positive urine protein and urinary erythrocyte accounted for 42.12%and 32.09%,respectively.IgG increased and complement C3 decreased significantly.ANA,anti-SSA antibody,anti-ds-DNA antibody,ANuA and AHA are the main positive rates in auto-antibodies.Urinary erythrocyte positive,increased IgG,and increased Cr are risk factors for renal damage in SSLE patients.The kidney,nervous system,blood system and lungs are mainly affected by young patients,while the heart and digestive system were mainly affected by middle-aged patients.2.In this group of cases,the TCM syndromes are mainly mixed with deficiency and solid.The solid syndromes are mainly blood stasis and dampness,and the deficiency syndromes are mainly qi deficiency,Yin deficiency,spleen,kidney deficiency,etc.The tongue colors are mainly light dark,red and dark red;the tongue coatings are mainly white greasy fur,thin white fur and yellow greasy fur;the pulse conditions are mainly thready pulse,rapid pulse and deep pulse.3.The treatment rate of integrated Chinese and western medicine is 98.85%,and the total effective rate is 89.11%.Most patients received the combination of hormone,propofol and immunosuppressant,and 43.55%received the impact of large dose of methylprednisolone,15.47%received the impact of large dose propofol,51.00%received the impact of cyclophosphamide.Three LN patients received kidney transplantation.The efficacy of Chinese medicine and proprietary Chinese medicine is mainly to nourish qi,remove blood stasis and dampness.Another 71.06%of the patients received TCM characteristic therapy.4.The clinical rescue rate of patients in this group is 13.75%,and the success rate is 85.98%.There is no statistical difference in the success rate between patients with the rescue times?3 times and>3 times.The case mortal ity rate is 6.02%,and the average age of death is 56.05±18.321 years old.There is no significant difference between male and female mortality in SSLE patients.Infection is the leading cause of death,followed by malignant tumor and lupus encephalopathy.Conclusion1.Integrated Chinese and western medicine have been widely used in the treatment of SSLE in our hospital,and the total effective rate is 89.11%.Large doses of hormones,propionate and cyclophosphamide remain the main methods for controlling the activity of severe lupus,and the patients treated with gamma globulin shock therapy had better tolerance.In recent years,plasma exchange,kidney transplantation,stem cell transplantation and other therapies have been also gradually developed.Chinese medicine combined with proprietary Chinese medicine and Chinese characteristic therapy are the characteristics of Chinese medicine treatment of SSLE in our hospital.2.The clinical manifestations of SSLE are complex and the pre-hospital misdiagnosis rate is high,it is necessary to improve the clinical understanding of SSLE.The kidney,nervous system and blood system are main damaged organs.The mortality rate of this group is 6.02%(21/349),slightly lower than that similar reports.Infection is the first lethal factor,suggesting that the adverse effect of infection on prognosis should be highly valued.The condition of patients should be closely monitored,and the prevention and anti-infection should be carried out throughout the treatment.In this group of cases,the total hospitalization cost is higher than similar reports,which may be related to the relatively complex treatment plan.Control ling the severity of SSLE patients' condition will help to reduce the treatment cost.3.In this group of cases,the combination of deficiency and solid are main syndromes.Blood stasis and dampness are prominent.Qi supplementation,removing blood stasis and dampness are the main treatment methods of TCM.