一项跨国前瞻性研究中狼疮低疾病活动状态（LLDAS）与健康相关生活质量的关联
Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study.
作者信息
Golder Vera, Kandane-Rathnayake Rangi, Hoi Alberta Yik-Bun, Huq Molla, Louthrenoo Worawit, An Yuan, Li Zhan Guo, Luo Shue Fen, Sockalingam Sargunan, Lau Chak Sing, Mok Mo Yin, Lateef Aisha, Franklyn Kate, Morton Susan, Navarra Sandra Teresa V, Zamora Leonid, Wu Yeong-Jian, Hamijoyo Laniyati, Chan Madelynn, O'Neill Sean, Goldblatt Fiona, Nikpour Mandana, Morand Eric Francis
机构信息
Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
The University of Melbourne, Melbourne, Australia.
出版信息
Arthritis Res Ther. 2017 Mar 20;19(1):62. doi: 10.1186/s13075-017-1256-6.
BACKGROUND
Systemic lupus erythematosus (SLE) is associated with significant impairment of health-related quality of life (HR-QoL). Recently, meeting a definition of a lupus low disease activity state (LLDAS), analogous to low disease activity in rheumatoid arthritis, was preliminarily validated as associated with protection from damage accrual. The LLDAS definition has not been previously evaluated for association with patient-reported outcomes. The objective of this study was to determine whether LLDAS is associated with better HR-QoL, and examine predictors of HR-QoL, in a large multiethnic, multinational cohort of patients with SLE.
METHODS
HR-QoL was measured using the Medical Outcomes Study 36-item short form health survey (SF-36v2) in a prospective study of 1422 patients. Disease status was measured using the SLE disease activity index (SLEDAI-2 K), physician global assessment (PGA) and LLDAS.
RESULTS
Significant differences in SF-36 domain scores were found between patients stratified by ethnic group, education level and damage score, and with the presence of active musculoskeletal or cutaneous manifestations. In multiple linear regression analysis, Asian ethnicity (p < 0.001), a higher level of education (p < 0.001), younger age (p < 0.001) and shorter disease duration (p < 0.01) remained significantly associated with better physical component scores (PCS). Musculoskeletal disease activity (p < 0.001) was negatively associated with PCS, and cutaneous activity (p = 0.04) was negatively associated with mental component scores (MCS). Patients in LLDAS had better PCS (p < 0.001) and MCS (p < 0.001) scores and significantly better scores in multiple individual SF-36 domain scores. Disease damage was associated with worse PCS (p < 0.001), but not MCS scores.
CONCLUSIONS
Ethnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.
背景
系统性红斑狼疮（SLE）与健康相关生活质量（HR-QoL）的显著受损有关。最近，达到狼疮低疾病活动状态（LLDAS）的定义，类似于类风湿关节炎的低疾病活动状态，已初步被证实与防止损伤累积相关。LLDAS定义此前尚未针对与患者报告结局的相关性进行评估。本研究的目的是在一个大型多民族、跨国的SLE患者队列中，确定LLDAS是否与更好的HR-QoL相关，并检查HR-QoL的预测因素。
方法
在一项对1422名患者的前瞻性研究中，使用医学结局研究36项简短健康调查（SF-36v2）测量HR-QoL。使用SLE疾病活动指数（SLEDAI-2K）、医生整体评估（PGA）和LLDAS来测量疾病状态。
结果
在按种族、教育水平和损伤评分分层的患者之间，以及存在活跃的肌肉骨骼或皮肤表现的患者之间，发现SF-36领域得分存在显著差异。在多元线性回归分析中，亚洲种族（p<0.001）、较高的教育水平（p<0.001）、较年轻的年龄（p<0.001）和较短的病程（p<0.01）仍然与更好的身体成分得分（PCS）显著相关。肌肉骨骼疾病活动（p<0.001）与PCS呈负相关，皮肤活动（p=0.04）与精神成分得分（MCS）呈负相关。处于LLDAS的患者具有更好的PCS（p<0.001）和MCS（p<0.001）得分，并且在多个单独的SF-36领域得分中显著更好。疾病损伤与较差的PCS（p<0.001）相关，但与MCS得分无关。
结论
种族、教育、疾病损伤和特定器官受累会影响SLE患者的HR-QoL。达到LLDAS与更好的HR-QoL相关。
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