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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (2): 273-278. doi: 10.19723/j.issn.1671-167X.2024.02.011

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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

任立敏1,赵楚楚1,赵义2,周惠琼3,张莉芸4,王友莲5,沈凌汛6,范文强7,李洋8,厉小梅9,王吉波10,程永静11,彭嘉婧1,赵晓珍1,邵苗1,李茹1,*()   

  1. 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
  • 收稿日期:2023-03-27 出版日期:2024-04-18 发布日期:2024-04-10
  • 通讯作者: 李茹 E-mail:doctorliru123@163.com

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

Limin REN1,Chuchu ZHAO1,Yi ZHAO2,Huiqiong ZHOU3,Liyun ZHANG4,Youlian WANG5,Lingxun SHEN6,Wenqiang FAN7,Yang LI8,Xiaomei LI9,Jibo WANG10,Yongjing CHENG11,Jiajing PENG1,Xiaozhen ZHAO1,Miao SHAO1,Ru Li1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
    3. Department of Rheumatology, the Fourth Medical Center of PLA General Hospital, Beijing 100142, China
    4. Department of Rheumatology, Shanxi Dayi Hospital, Taiyuan 030032, China
    5. Department of Rheumatology, Jiangxi Provincial People's Hospital, Nanchang 330006, China
    6. Department of Immunology and Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
    7. Department of Rheumatology and Immunology, The Fourth Clinical College of Xinxiang Medical University, Xinxiang 453099, Henan, China
    8. Department of Rheumatology and Immunology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, China
    9. Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei 230001, China
    10. Department of Rheumatology, The Affliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
    11. Department of Rheumatology and Immunology, Beijing Hospital, Beijing 100730, China
  • Received:2023-03-27 Online:2024-04-18 Published:2024-04-10
  • Contact: Ru Li E-mail:doctorliru123@163.com

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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。

关键词: 系统性红斑狼疮, 缓解, 狼疮低疾病活动状态

Abstract:

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.

Key words: Systemic lupus erythematosus, Remission, Lupus low disease activity state

中图分类号: 

  • R593.24

表1

符合与不符合DORIS或LLDAS的SLE患者临床特点对比"

ItemsDORIS (n=104) LLDAS (n=207)
Met Unmet P Met Unmet P
Female 99 (95.2) 819 (91.4) 0.183 196 (94.7) 722 (91.0) 0.089
Age/years 37.3±13.1 37.0±13.5 0.843 37.4±12.8 37.0±13.6 0.713
Northern region 88 (84.6) 723 (80.7) 0.333 171 (82.6) 640 (80.7) 0.534
Married 82 (78.8) 712 (79.5) 0.883 168 (81.2) 626 (78.9) 0.482
Bachelor’s degree or above 71 (68.2) 635 (70.9) 0.582 152 (73.4) 554 (69.9) 0.316
On-the-job 69 (66.3) 548 (61.2) 0.303 138 (66.7) 479 (60.4) 0.099
Outworker 16 (15.3) 134 (15.0) 0.908 23 (11.1) 127 (16.0) 0.078
Household income≥1 000 yuan per month 102 (98.1) 825 (92.1) 0.026 199 (96.1) 728 (91.8) 0.033
Family history 19 (18.2) 112 (12.5) 0.099 28 (13.5) 103 (13.0) 0.838
Disease duration/months 76.2±59.2 58.9±68.4 0.013 72.4±57.4 57.7±69.8 0.005
Increased ESR 34 (32.7) 458 (51.1) ＜0.001 80 (38.6) 412 (52.0) 0.001
Hypoproteinemia 20 (19.2) 368 (41.2) 0.023 59 (28.5) 329 (41.5) 0.001
Anemia 24 (23.1) 297 (33.1) 0.048 59 (28.5) 262 (33.0) 0.213
Elevated creatinine 1 (0.1) 40 (4.5) 0.046 5 (2.4) 36 (4.5) 0.171

图1

HCQ及免疫抑制剂疗程对SLE患者疾病活动度的影响"

表2

影响SLE患者达到LLDAS或DORIS缓解的多因素Logistic分析"

VariablesLLDAS DORIS
OR (95%CI) P OR (95%CI) P
Increased ESR 0.63 (0.45, 0.88) ＜0.01 0.50 (0.31, 0.81) ＜0.01
Positive anti-dsDNA antibodies 0.40 (0.27, 0.60) ＜0.01 0.24 (0.12, 0.48) ＜0.01
Low complement C3 0.55 (0.37, 0.83) ＜0.01 0.29 (0.15, 0.54) ＜0.01
Low complement C4 0.63 (0.42, 0.94) 0.025 0.32 (0.17, 0.60) ＜0.01
Urine protein≥0.5 g/d 0.31 (0.19, 0.52) ＜0.01 0.21 (0.08, 0.55) ＜0.01
Low household income (＜1 000 yuan per month) 0.44 (0.21, 0.93) 0.028 0.21 (0.05, 0.88) 0.033
HCQ usage for longer than 12 months 3.10 (2.15, 4.45) ＜0.01 2.35 (1.46, 3.78) ＜0.01
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ISSN 1671-167X
CN 11-4691/R
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