中国狼疮肾炎患者的临床特征及治疗选择:基于CSTAR队列的研究  

Clinical characteristics and treatment options of Chinese patients with lupus nephritis:a CSTAR cohort study

作　　者：白炜 段新旺[2] 李芹[3] 徐健[4] 詹锋[5] 赵铖[6] 姜振宇[7] 李志军[8] 武丽君[9] 刘升云[10] 杨敏[11] 魏蔚[12] 李鸿斌[13] 赵久良 王迁 冷晓梅 田新平 李梦涛 曾小峰 BAI Wei;DUAN Xin-wang;LI Qin;XU Jian;ZHAN Feng;ZHAO Cheng;JIANG Zhen-yu;LI Zhi-jun;WU Li-jun;LIU Sheng-yun;YANG Min;WEI Wei;LI Hong-bin;ZHAO Jiu-liang;WANG Qian;LENG Xiao-mei;TIAN Xin-ping;LI Meng-tao;ZENG Xiao-feng(Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID),State Key Laboratory of Complex Severe and Rare Diseases,Ministry of Science&Technology,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Beijing 100730,China;Department of Rheumatology and Immunology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China;Department of Rheumatology and Immunology,the first people's Hospital of Yunnan Province,Kunming 650034,Yunnan,China;Department of Rheumatology and Immunology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China;Department of Rheumatology and Immunology,Hainan General Hospital,Haikou 570311,Hainan,China;Department of Rheumatology and Immunology,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;Department of Rheumatology and Immunology,the First Bethune Hospital of Jilin University,Changchun 130061,Jilin,China;Department of Rheumatology and Immunology,the Affiliated Hospital of Bengbu Medical College,Bengbu 233099,Anhui,China;Department of Rheumatology and Immunology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,Xinjiang,China;Department of Rheumatology and Immunology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Rheumatology and Immunology,Nanfang Hospital of Southern Medical University,Guangzhou 510515,Guangdong,China;Department of Rheumatology and Immunology,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Rheumatology and Immunology,the Affiliated Hospital of Inner Mongolia Medical Univer

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,国家皮肤与免疫疾病临床医学研究中心,疑难重症及罕见病国家重点实验室,风湿免疫病学教育部重点实验室,北京100730 [2]南昌大学第二附属医院风湿免疫科,南昌330006 [3]云南省第一人民医院风湿免疫科,昆明650034 [4]昆明医科大学第一附属医院风湿免疫科,昆明650032 [5]海南省人民医院风湿免疫科,海口570311 [6]广西医科大学第一附属医院风湿免疫科,南宁530021 [7]吉林大学第一医院风湿免疫科,长春130061 [8]蚌埠医学院附属医院风湿免疫科,安徽蚌埠233099 [9]新疆维吾尔自治区人民医院风湿免疫科,乌鲁木齐830001 [10]郑州大学第一附属医院风湿免疫科,郑州450052 [11]南方医科大学南方医院风湿免疫科,广州510515 [12]天津医科大学总医院风湿免疫科,天津300052 [13]内蒙古医科大学附属医院风湿免疫科,呼和浩特010050

出　　处：《中华临床免疫和变态反应杂志》2021年第3期275-285,共11页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家重点研发计划精准医学专项(2017YFC0907601,2017YFC0907602,2017YFC0907603);北京市科学技术委员会资助项目(Z201100005520022,Z201100005520023,Z201100005520025,Z201100005520026,Z201100005520027);中国医学科学院医学与健康科技创新工程项目(2019-I2M-2-008)。

摘　　要：目的分析总结狼疮肾炎(lupus nephritis,LN)患者的临床特征及初始治疗选择,提高对中国LN患者的认识。方法基于中国系统性红斑狼疮(systemic lupus erythematosus,SLE)研究协作组(Chinese SLE Treatment and Research group,CSTAR)建立的SLE起始队列,分析2009年2月至2021年3月登记注册的确诊时间在3个月内的8713例SLE患者及其中LN患者的基线人口学特征、临床表现、实验室检查以及治疗选择。结果在初始诊断的SLE患者中,LN发生率为33.3%(2900/8713)。LN患者肾脏病理活检以Ⅳ型LN最多见(35.1%)。LN组患者男性比例更高(12.0%vs.7.7%,P<0.001),SLEDAI评分更高(11.7±8.5 vs.6.6±6.2,P<0.001),SLICC/ACR脏器损伤评分≥1分的比例更高(34.0%vs.16.6%,P<0.001)。单因素及多因素分析结果显示血小板减少(23.2%vs.16.6%,P<0.001)、浆膜炎(19.2%vs.8.4%,P<0.001)、神经精神狼疮(7.6%vs.5.5%,P=0.001)、肌炎(3.3%vs.2.1%,P=0.006)、低补体血症(66.0%vs.53.1%,P<0.001)、抗dsDNA阳性(54.4%vs.42.4%,P<0.001)与LN相关,而LN患者关节炎发生比例降低(26.8%vs.30.4%,P<0.001)。与非LN组相比,LN组患者初始治疗方案中糖皮质激素(90.7%vs.84.1%,P<0.001)及激素冲击治疗(9.1%vs.3.4%,P<0.001)、环磷酰胺(27.0%vs.11.7%,P<0.001)、霉酚酸酯(21.6%vs.10.1%,P<0.001)、他克莫司(4.8%vs.2.3%,P<0.001)应用比例显著增高,而羟氯喹(67.4%vs.73.1%,P<0.001)、环孢素(4.3%vs.5.9%,P=0.002)应用比例显著降低。结论SLE中LN组较非LN组患者男性比例更高,病情活动度高,脏器损伤重。LN与浆膜炎、血小板减少等提示SLE病情活动的临床表现及实验室指标相关,初始治疗更积极。Objective To analyze and summarize the clinical characteristics and initial treatment options of lupus nephritis(LN)patients,so as to improve the understanding of Chinese LN patients.MethodsBased on the systemic lupus erythematosus(SLE)inception cohort established by the Chinese SLE Treatment and Research group(CSTAR),we analyzed the baseline demographic characteristics,clinical manifestations,laboratory parameters,and initial treatment options of 8713 SLE patients and LN patients who were diagnosed within 3 months from February 2009 to March 2021.Results The incidence of LN was 33.3%(2900/8713).The most common pathology type was classⅣLN(35.1%).The proportion of men in LN group was higher than that in non-LN group(12.0%vs.7.7%,P<0.001).Patients in LN group had higher SLE disease activity index(SLEDAI)score(11.7±8.5 vs.6.6±6.2,P<0.001).Also,there were more patients with the systemic lupus International Collaborating Clinics(SLICC)/American College of Rheumatology(ACR)damage index≥1(34.0%vs.16.6%,P<0.001)in LN group.Univariate and multivariate analysis showed that thrombocytopenia(23.2%vs.16.6%,P<0.001),serositis(19.2%vs.8.4%,P<0.001),neuropsy-chiatric lupus erythematosus(7.6%vs.5.5%,P=0.001),myositis(3.3%vs.2.1%,P=0.006),hypocompleminemia(66.0%vs.53.1%,P<0.001),and anti-dsDNA positive(54.4%vs.42.4%,P<0.001)were associated with LN;while the incidence of arthritis in LN patients decreased(26.8%vs.30.4%,P<0.001).Compared with the non-LN group,the use rate of glucocorticoid(90.7%vs.84.1%,P<0.001)and pulse therapy(9.1%vs.3.4%,P<0.001),cyclophosphamide(27.0%vs.11.7%,P<0.001),mycophenolate mofetil(21.6%vs.10.1%,P<0.001),and tacrolimus(4.8%vs.2.3%,P<0.001)in the initial treatment regimen of LN group were significantly higher;while frequency of use of hydroxychloroquine(67.4%vs.73.1%,P<0.001)and cyclosporin(4.3%vs.5.9%,P=0.002)were significantly lower.ConclusionsIn newly diagnosed SLE patients,the proportion of male patients with LN is higher,and the patients with LN have higher disease activity and severe organ dam

关 键 词：系统性红斑狼疮 狼疮肾炎 SLE疾病活动指数 临床特征 治疗 

分 类 号：R59[医药卫生—内科学]