系统性红斑狼疮维持治疗中撤停糖皮质激素的效果分析  

Retrospective analysis of glucocorticoids withdrawal in maintenance treatment of systemic lupus erythematosus

作　　者：陈瑞林[1] 温嘉妍 黄文辉[1] CHEN Rui-lin;WEN Jia-yan;HUANG Wen-hui(Department of Rheumatology and Immunology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong,China)

机构地区：[1]广州医科大学附属第二医院风湿免疫科,广东广州510260

出　　处：《广东医学》2020年第21期2219-2224,共6页Guangdong Medical Journal

摘　　要：目的探讨临床静止期系统性红斑狼疮在维持治疗中撤停激素的可行性.方法回顾性分析84例临床静止期的系统性红斑狼疮患者,按维持治疗方法的不同分为激素撤停组(n=41)和激素维持组(n=43).观察主要终点指标为复发率,次要终点指标为病情稳定到出现复发的时间、复发严重程度和不良反应发生率.结果激素撤停组和激素维持组患者SELENA-SLEDAI评分的差异无统计学意义(P>0.05).两组血沉、抗ds-DNA抗体阳性率和低补体C3的患者比例差异无统计学意义(P>0.05).激素维持组中出现11例复发,复发率为25.6%(11/43),激素撤停组中出现7例复发,复发率为17.1%(7/41),但差异无统计学意义(P>0.05).根据系统性红斑狼疮发作指数,两组复发严重程度差异无统计学意义(P>0.05).激素撤停组不良反应发生率低于激素维持组(22.0%vs 44.2%,P<0.05).其中,激素撤停组的感染发生率和骨质疏松症发生率均低于激素维持组(P<0.05).结论对于长期处于临床静止期的系统性红斑狼疮患者来说,撤停激素这一目标是可实现的.Objective To evaluate the feasibility of glucocorticoids(GCs)withdraw in the maintenance treatment of systemic lupus erythematosus(SLE)in the stationary phase.Methods Eighty-four patients with clinically quiescent SLE were included.In this study,84 patients were divided into GCs withdrawal group(n=41)and GCs maintenance group(n=43)according to the maintenance therapy.The primary endpoint was flare rate.The secondary endpoint was the time to flare,flare severity and incidence of adverse events.Results There was no significant difference in the SELENA-SLEDAI score between the GCs withdrawal group and the GCs maintenance group(P>0.05).There was no significant difference between the two groups in ESR,the positive rate of anti-dsDNA antibody and the proportion of patients with low complement C3(P>0.05).There were 11 relapses in the GCs maintenance group,with the recurrence rate of 25.6%(11/43);and 7 cases in the GCs withdrawal group,with the recurrence rate of 17.1%(7/41);but the difference was not statistically significant(P>0.05).According to the SELENA-SLEDAI flare index,there were 6 cases with mild/moderate flare in GCs maintenance group(54.5%)and 5 cases in GCs withdrawal group(71.4%).There was no significant difference in the flare severity between two groups(P>0.05).The incidence of adverse reactions in the GCs withdrawal group was significantly lower than that in the GCs maintenance group(P<0.05).Among them,the incidence of infection and osteoporosis in the GCs withdrawal group were significantly lower than those in the GCs maintenance group(P<0.05).Conclusion For SLE patients who are in clinical quiescence for a long time,withdrawal of GCs is achievable.

关 键 词：系统性红斑狼疮 临床静止期 糖皮质激素 撤停 

分 类 号：R539.241[医药卫生—内科学] Q548.2[医药卫生—临床医学]