Pediatric Rheumatology, University of California, San Francisco, CA 94143, USA.
Best Pract Res Clin Rheumatol. 2009 Oct;23(5):699-708. doi: 10.1016/j.berh.2009.07.008.
Although more commonly presenting in adulthood, approximately 15-20% of systemic lupus erythematosus (SLE) cases occur before age 16 years. Unfortunately, SLE is usually more severe when presenting in childhood, and frequently involves vital organs such as the kidney. Over the past several decades, mortality rates have dropped, largely due to earlier diagnosis, improved management of the SLE and improved general medical care to reduce infection. Treatment strategies for nephritis in children is largely adopted from experience in adults, and the recent advances in therapeutic options for adults have brought new treatment to children. However, determining efficacy is difficult due to the absence of clinical trial data. Furthermore, determination of safety in a developing child or adolescent cannot be extrapolated from adult studies. As survival has improved, numerous secondary complications have emerged, including early atherosclerosis. As for adults with SLE, it is generally accepted that atherogenesis in SLE results from both disease- and treatment-related factors. Most surprising is that persons with childhood-onset SLE can develop myocardial ischaemia as early as 20-30 years of age. Better understanding of the pathogenesis and development of preventative strategies is needed to ensure that these young people do not succumb to atherosclerosis instead of to SLE.
虽然系统性红斑狼疮（SLE）约有 15-20%的病例发生在 16 岁之前，但通常更常见于成年后发病。不幸的是，儿童时期发病的 SLE 通常更为严重，并且经常涉及肾脏等重要器官。在过去的几十年中，由于早期诊断、SLE 管理的改善以及改善一般医疗保健以减少感染，死亡率有所下降。儿童肾炎的治疗策略主要是借鉴成人的经验，而成人治疗选择的最新进展为儿童带来了新的治疗方法。然而，由于缺乏临床试验数据，确定疗效具有一定难度。此外，由于无法从成人研究中推断出在发育中的儿童或青少年中的安全性。随着生存状况的改善，出现了许多继发性并发症，包括早期动脉粥样硬化。与成人 SLE 一样，人们普遍认为 SLE 中的动脉粥样硬化形成既与疾病有关，也与治疗有关。最令人惊讶的是，儿童发病的 SLE 患者早在 20-30 岁时就可能发生心肌缺血。为了确保这些年轻人不会因动脉粥样硬化而不是 SLE 而屈服，需要更好地了解发病机制和制定预防策略。
