Aranow Cynthia
Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.
Immunol Res. 2015 Dec;63(1-3):167-9. doi: 10.1007/s12026-015-8712-7.
The Physician Global Assessment (PGA) is an important and useful outcome measurement of lupus disease activity, but consensus on whether the PGA should be performed prior to or after the receipt of laboratory values is lacking. The objective of this study was to collect preliminary data on the optimal time to perform a PGA. In this pilot study, a PGA was performed by a single clinician upon completion of an outpatient clinical encounter and again after receipt of pertinent laboratory values. Laboratory values obtained at each clinical visit included a CBC, comprehensive chemistries, C3, C4, anti-dsDNA antibody levels, urinalysis and, if pertinent, a spot urinary protein/creatinine ratio. Disease activity was additionally determined by the SELENA-SLEDAI. Fifty-four patients, 3 males and 51 females with an average SLE disease duration of 12.3 (SD 10.5) years contributed 74 assessments to this study. The average SELENA-SLEDAI was 2.2. The average pre-laboratory PGA was 0.46, and the average post-laboratory PGA was 0.55 (p < 0.02 paired Student's t test). Among the 48 encounters with active disease and a mean SELENA-SLEDAI of 3.37, concordance of the pre-laboratory and post-laboratory PGAs occurred in only third of the patient encounters. Both pre- and post-PGA correlated with the SELENA-SLEDAI. However, the correlation of the post-PGA with the SELENA-SLEDAI was significantly greater than the correlation of the pre-PGA and SELENA-SLEDAI [r = 0.69 vs 0.79, respectively (p < 0.0179)]. In some lupus patients, the PGA determined prior to receipt of laboratory values may be the same as the PGA determined after laboratory values are received. However, in these preliminary data, there was a significant difference between pre-laboratory and post-laboratory PGA with a significantly greater correlation of the post-laboratory PGA with the SELENA-SLEDAI. Further studies in a larger patient population with a greater range of disease activity are needed to confirm and extend these findings.
医师整体评估（PGA）是狼疮疾病活动度一项重要且有用的结局指标，但对于PGA应在获取实验室检查结果之前还是之后进行，目前尚未达成共识。本研究的目的是收集关于进行PGA的最佳时间的初步数据。在这项试点研究中，由一名临床医生在门诊临床诊疗结束时进行一次PGA，并在获取相关实验室检查结果后再次进行。每次临床就诊时获得的实验室检查结果包括全血细胞计数、综合生化指标、C3、C4、抗双链DNA抗体水平、尿液分析，以及必要时的随机尿蛋白/肌酐比值。疾病活动度还通过SELENA-SLEDAI进行测定。54例患者（3例男性和51例女性）参与了本研究，平均SLE病程为12.3（标准差10.5）年，共提供了74次评估。平均SELENA-SLEDAI为2.2。实验室检查前的平均PGA为0.46，实验室检查后的平均PGA为0.55（配对t检验，p<0.02）。在48次疾病活动且平均SELENA-SLEDAI为3.37的诊疗中，实验室检查前和实验室检查后的PGA仅有三分之一的患者诊疗结果一致。PGA检查前和检查后均与SELENA-SLEDAI相关。然而，实验室检查后PGA与SELENA-SLEDAI的相关性显著大于实验室检查前PGA与SELENA-SLEDAI的相关性[r分别为0.69和0.79（p<0.0179）]。在一些狼疮患者中，在获取实验室检查结果之前确定的PGA可能与获取实验室检查结果之后确定的PGA相同。然而，根据这些初步数据，实验室检查前和实验室检查后的PGA之间存在显著差异，且实验室检查后PGA与SELENA-SLEDAI的相关性显著更高。需要在更大范围的疾病活动度的更大患者群体中进行进一步研究，以证实并扩展这些发现。
