系统性红斑狼疮低疾病活动度及缓解状况的真实世界研究  

Low disease activity and remission status of systemic lupus erythematosus in a real-world study

作　　者：任立敏[1] 赵楚楚[1] 赵义[2] 周惠琼 张莉芸 王友莲[5] 沈凌汛 范文强 李洋[8] 厉小梅[9] 王吉波[10] 程永静[11] 彭嘉婧 赵晓珍 邵苗[1] 李茹 REN Limin;ZHAO Chuchu;ZHAO Yi;ZHOU Huiqiong;ZHANG Liyun;WANG Youlian;SHEN Lingxun;FAN Wenqiang;LI Yang;LI Xiaomei;WANG Jibo;CHENG Yongjing;PENG Jiajing;ZHAO Xiaozhen;SHAO Miao;Li Ru(Department of Rheumatology and Immunology,Peking University People’s Hospital,Beijing 100044,China;Department of Rheumatology and Immunology,Xuanwu Hospital Capital Medical University,Beijing 100053,China;Department of Rheumatology,the Fourth Medical Center of PLA General Hospital,Beijing 100142,China;Department of Rheumatology,Shanxi Dayi Hospital,Taiyuan 030032,China;Department of Rheumatology,Jiangxi Provincial People’s Hospital,Nanchang 330006,China;Department of Immunology and Rheumatology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Rheumatology and Immunology,The Fourth Clinical College of Xinxiang Medical University,Xinxiang 453099,Henan,China;Department of Rheumatology and Immunology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Rheumatology and Immunology,Anhui Provincial Hospital,Hefei 230001,China;Department of Rheumatology,The Affliated Hospital of Qingdao University,Qingdao 266000,Shandong,China;Department of Rheumatology and Immunology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京大学人民医院风湿免疫科,北京100044 [2]首都医科大学宣武医院风湿免疫科,北京100053 [3]解放军总医院第四医学中心风湿免疫科,北京100142 [4]山西大医院风湿免疫科,太原030032 [5]江西省人民医院风湿免疫科,南昌330006 [6]华中科技大学协和医院风湿免疫科,武汉430022 [7]新乡医学院附属中心医院风湿免疫科,河南新乡453099 [8]哈尔滨医科大学附属第二医院风湿免疫科,哈尔滨150001 [9]安徽省立医院风湿免疫科,合肥230001 [10]青岛大学附属医院风湿免疫科,山东青岛266000 [11]北京医院风湿免疫科,北京100730

出　　处：《北京大学学报（医学版）》2024年第2期273-278,共6页Journal of Peking University:Health Sciences

摘　　要：目的:研究系统性红斑狼疮(systemic lupus erythematosus, SLE)患者的真实世界低疾病活动度和临床缓解率,并分析其相关因素。方法:采用现场调查的研究方法,对国内11家医院1 000例SLE患者进行问卷调查,记录患者的一般资料、临床表现、实验室检查结果和治疗情况等。采用狼疮低疾病活动状态(lupus low disease activity state, LLDAS)和SLE缓解定义(definitions of remission in SLE,DORIS)评价患者低疾病活动度和临床缓解率,进一步分析符合LLDAS或DORIS缓解患者的临床特征。多因素Logistic回归分析影响LLDAS或DORIS缓解的相关因素。结果:1 000例SLE患者中,207例(20.7%)符合LLDAS标准,104例(10.4%)符合DORIS缓解。与不符合LLDAS或DORIS的患者相比,符合LLDAS或DORIS者高收入比例更高,病程更长,贫血、肌酐升高、红细胞沉降率增快和低白蛋白血症的发生率更低。应用羟氯喹>12个月或免疫抑制剂≥6个月的SLE患者缓解比例较高。多因素Logistic回归分析发现,红细胞沉降率增快、抗双链DNA抗体阳性、低补体血症(C3和C4)、蛋白尿及家庭收入低是不利于达到LLDAS或DORIS缓解的独立相关因素,而应用羟氯喹>12个月为达到LLDAS或DORIS缓解的保护因素。结论:SLE患者达到LLDAS或DORIS缓解状态的比例较低,规范应用羟氯喹和免疫抑制剂有助于患者的病情缓解。Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7%of patients met the criteria of LLDAS,while 10.4%of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine elevation,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household income were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

关 键 词：系统性红斑狼疮 缓解 狼疮低疾病活动状态 

分 类 号：R593.24[医药卫生—内科学]