Becker-Merok Andrea, Nossent Hans C
Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
J Rheumatol. 2006 Aug;33(8):1570-7.
To describe damage accrual and the interconnections between disease activity measures, damage accrual, and death in a Nordic lupus cohort.
Longitudinal study in the population-based Tromso lupus cohort. Disease activity [SLE Disease Activity Index (SLEDAI)] and disease damage [by Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI)] were recorded for each visit. Weighted average SLEDAI scores (WAS) were calculated to correct for variable observation times. Development of damage (SDI > 0), severe damage (SDI >or= 3), and death were used as separate endpoints. Univariate nonparametric analysis identified and hazard ratios (HR) by Cox regression techniques confirmed the independence of predictors for each outcome.
Through 11.9 years of followup, 72 patients (46%) remained free of damage, 51 (32%) developed moderate damage, and 35 (22%) developed severe damage. SDI scores were higher in 37 nonsurvivors (23.4%; SDI 2.1) than in survivors (SDI 0.9; p < 0.05). Damage accrual was linear throughout the first decade of disease. The only independent predictor for SDI >/= 3 was a WAS score > 3 (hazard ratio 2.34; 95% CI 1.1-4.9). Age > 40 years at diagnosis (HR 5.6, 95% CI 2.4-12.7) and WAS > 3 (HR 2.4, 95% CI 1.2-4.9) were significant predictors for death.
Damage accrual in SLE occurred in 54% of patients in a linear fashion over the first decade of disease. Global disease activity was the main determinant of damage accrual. Accrued damage was not an independent risk factor for death, which was predicted by age > 40 years and WAS > 3.
描述北欧狼疮队列中损伤累积情况以及疾病活动度指标、损伤累积和死亡之间的相互联系。
在基于人群的特罗姆瑟狼疮队列中进行纵向研究。每次随访时记录疾病活动度[SLE疾病活动指数（SLEDAI）]和疾病损伤[采用系统性红斑狼疮国际协作临床组（SLICC）/美国风湿病学会（ACR）损伤指数（SDI）]。计算加权平均SLEDAI评分（WAS）以校正不同的观察时间。将损伤进展（SDI>0）、严重损伤（SDI≥3）和死亡作为单独的终点。单变量非参数分析确定预测因素，通过Cox回归技术计算的风险比（HR）证实了各结局预测因素的独立性。
经过11.9年的随访，72例患者（46%）未出现损伤，51例（32%）出现中度损伤，35例（22%）出现严重损伤。37例非幸存者的SDI评分（23.4%；SDI为2.1）高于幸存者（SDI为
0.9；p<0.05）。在疾病的第一个十年中，损伤累积呈线性。SDI≥3的唯一独立预测因素是WAS评分>3（风险比2.34；95%可信区间1.1 - 4.9）。诊断时年龄>40岁（HR 5.6，95%可信区间2.4 - 12.7）和WAS>3（HR 2.4，95%可信区间1.2 - 4.9）是死亡的显著预测因素。
在疾病的第一个十年中，54%的SLE患者出现线性损伤累积。整体疾病活动度是损伤累积的主要决定因素。累积损伤不是死亡的独立危险因素，年龄>40岁和WAS>3可预测死亡。
