系统性红斑狼疮零激素与零用药的可能性  

Possible discontinuation of glucocorticoids and complete withdrawal of therapy in patients with systemic lupus erythematosus

作　　者：刘海波[1] 曹华[2] 桑红[1] Liu Haibo;Cao Hua;Sang Hong(Department of Dermatology,General Hospital of Eastern Theater Command(previously named as Nanjing General Hospital of Nanjing Military Command),Nanjing 210002,China;Department of Dermatology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)皮肤科,南京210002 [2]上海交通大学医学院附属瑞金医院皮肤科,200025

出　　处：《中华皮肤科杂志》2020年第10期849-853,共5页Chinese Journal of Dermatology

基　　金：江苏省皮肤病学创新团队项目(CXTDA2017038);中国博士后科学基金资助项目(2015T81134)

摘　　要：近年来,达标治疗策略在系统性红斑狼疮(SLE)治疗中取得了巨大进展。达标治疗理念认为,SLE患者治疗的主要目标是获得并保持临床缓解,如不能达到临床缓解,则以达到低疾病活动度为次要目标。达到治疗目标并维持一定时间后,则可尝试糖皮质激素逐渐减量,如有可能可以完全停用。在持续获得临床缓解的患者中,可继续尝试逐渐减停免疫抑制剂和抗疟药物。在保持低疾病活动度的患者中,则可尝试免疫抑制剂逐渐减量。达标治疗理念为SLE零激素与零用药指明了方向并提供了可能性。本文总结了SLE达标治疗的最新理念,探讨了该理念对SLE治疗中糖皮质激素、免疫抑制剂以及抗疟药减停的影响及指导意义。In recent years,great advances have been made in application of treat-to-target(T2T)strategy to the treatment of systemic lupus erythematosus(SLE).In T2T strategy,it is suggested that the main target in SLE treatment should be the attainment and maintenance of clinical remission;if clinical remission cannot be achieved,low disease activity could be an alternative target;when the treatment target is achieved and maintained for a period,physicians can try to reduce and minimize glucocorticoids and,if possible,glucocorticoids should be withdrawn completely;in patients in sustained clinical remission,the next step would be to reduce and stop immunosuppressants and antimalarials;in patients in sustained low disease activity,the next step would be to reduce immunosuppressants.In sum,T2T strategy offers the direction and provides the possibility of discontinuation of glucocorticoids and complete withdrawal of therapy in patients with SLE.This review summarizes the new concept of T2T in SLE treatment,and discusses the effect and guiding significance of T2T on discontinuation of glucocorticoids,immunosuppressants and antimalarials.

关 键 词：红斑狼疮 系统性 糖皮质激素类 达标治疗 临床缓解 低疾病活动度 零用药 

分 类 号：R593.241[医药卫生—内科学]