Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Beijing, 100730, China.
Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Science, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100005, China.
Clin Rheumatol. 2017 Dec;36(12):2727-2732. doi: 10.1007/s10067-017-3842-z. Epub 2017 Sep 19.
This study determined the flare status of SLE patients in a single-center Chinese cohort and identified the predictors of flare in this underreported Asian population. The patients were recruited from April 2009 to February 2010 at the Peking Union Medical College Hospital (PUMCH), and then followed up regularly at our clinic until December 2015. Flare was defined as an increase in SLEDAI-2K to ≥ 4 points from the previous visit, or appearing of a new SLE manifestation or worsening of a preexisting clinical or hematological manifestation (not included in SLEDAI-2K) that results in restarting or increasing corticosteroids or immunosuppressant. Baseline and follow-up data were collected, and some of them were used as variables in survival analysis for time-to-flare outcome with Kaplan-Meier survival analysis and log-rank tests. Potential predictors with significant differences were further included in a multivariate Cox regression model for confounders adjustment and hazard ratio (HR) calculation. A total of 254 patients were finally included in our analysis. Yearly flare proportion rate was 13.0-15.7%. Renal, hematologic, and neurologic were the most frequently involved organs. Multivariate analysis confirmed onset age up to 18 years (HR 2.14, 95% CI 1.09-4.19) as a flare predictor. Organ damage at entry also showed an association trend with flare (HR = 1.693, 95% CI 0.943 ~ 3.041, p = 0.078). Chinese SLE patients showed a higher prevalence for disease flare compared with other ethnics. Future studies should be designed for figuring out the prediction role of fluctuation of anti-dsDNA antibody for disease flare.
这项研究在一个单中心的中国队列中确定了 SLE 患者的 flares 状态，并确定了在这个报告不足的亚洲人群中 flares 的预测因素。患者于 2009 年 4 月至 2010 年 2 月在北京协和医院（PUMCH）招募，并在我们的诊所定期随访至 2015 年 12 月。 flares 被定义为从上次就诊时 SLEDAI-2K 增加≥4 分，或出现新的 SLE 表现或先前存在的临床或血液学表现恶化（不包括在 SLEDAI-2K 中），导致重新开始或增加皮质类固醇或免疫抑制剂。收集基线和随访数据，其中一些数据用于 Kaplan-Meier 生存分析和对数秩检验的生存分析中，以分析 flares 时间的结果变量。具有显著差异的潜在预测因素被进一步纳入多变量 Cox 回归模型，以进行混杂因素调整和危险比（HR）计算。共有 254 名患者最终纳入我们的分析。每年 flares 的比例为 13.0-15.7%。肾脏、血液和神经是最常受累的器官。多变量分析证实，发病年龄在 18 岁及以下（HR 2.14，95%CI 1.09-4.19）是 flares 的预测因素。入组时的器官损伤也与 flares 呈关联趋势（HR=1.693，95%CI 0.943~3.041，p=0.078）。与其他种族相比，中国 SLE 患者的疾病 flares 发生率更高。未来的研究应设计用于确定抗 dsDNA 抗体波动对疾病 flares 的预测作用。
