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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OACSTPCD

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

中文摘要英文摘要

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,LLD AS)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 eleva-tion,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 in-come 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.

任立敏;厉小梅;王吉波;程永静;彭嘉婧;赵晓珍;邵苗;李茹;赵楚楚;赵义;周惠琼;张莉芸;王友莲;沈凌汛;范文强;李洋

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

临床医学

系统性红斑狼疮缓解狼疮低疾病活动状态

Systemic lupus erythematosusRemissionLupus low disease activity state

《北京大学学报(医学版)》 2024 (002)

273-278 / 6

10.19723/j.issn.1671-167X.2024.02.011

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