Miyawaki Y, Sada K, Asano Y, Hayashi K, Yamamura Y, Hiramatsu S, Ohashi K, Morishita M, Watanabe H, Matsumoto Y, Kawabata T, Wada J
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Lupus. 2018 Nov;27(13):2093-2100. doi: 10.1177/0961203318804892. Epub 2018 Oct 11.
Serologically active clinically quiescent (SACQ)-SLE is a subtype of systemic lupus erythematosus (SLE); most SACQ-SLE patients relapse. Although complement and/or anti-dsDNA level fluctuations during SACQ status are reportedly not useful for predicting relapse, they might be useful in specific clinical settings. We aimed to assess the correlation between future relapse and progressive reductions in serum complement levels following remission in patients with hypocomplementemia .
We retrospectively reviewed patients aged ≥15 years who were treated with ≥20 mg/day of prednisolone for remission induction. After achieving remission, the patients treated with prednisolone tapered to ≤15 mg/day without relapse and followed by hypocomplementemia (first hypocomplementemia point) were analyzed. The primary outcome was the relapse during the first 24 months.
Seventy-six patients were enrolled; 31 (40.8%) relapsed. A ≥10% reduction after the first hypocomplementemia point in serum C3, C4, and CH50 levels was found in 10, 21, and 16 patients, respectively. Hazard ratios (95% confidence intervals) for relapse were 2.32 (0.92-5.12) for serum C3 levels and 2.46 (1.18-5.01) for serum C4 levels. Progressive reductions in serum C3 and C4 levels had relatively high specificity (93.3% and 82.2%) but limited sensitivity (22.6% and 41.9%) for predicting relapse. However, simultaneous progressive reduction in C3 levels and increase in anti-dsDNA antibody levels had the highest specificity (97.8%), and simultaneous progressive reduction in C4 levels or increase in anti-dsDNA antibody levels had the highest sensitivity (71.0%).
Simultaneous progressive reductions in complement levels and increases in anti-dsDNA antibody levels may indicate future relapse SACQ-SLE patients.
血清学活跃临床静止（SACQ）-系统性红斑狼疮（SLE）是系统性红斑狼疮的一种亚型；大多数SACQ-SLE患者会复发。尽管据报道SACQ状态期间补体和/或抗双链DNA水平波动对预测复发无用，但它们可能在特定临床环境中有用。我们旨在评估低补体血症患者缓解后血清补体水平逐渐降低与未来复发之间的相关性。
我们回顾性分析了年龄≥15岁、接受≥20mg/天泼尼松龙诱导缓解治疗的患者。缓解后，对泼尼松龙减量至≤15mg/天且无复发并随后出现低补体血症（第一个低补体血症点）的患者进行分析。主要结局是前24个月内的复发情况。
共纳入76例患者；31例（40.8%）复发。分别在10例、21例和16例患者中发现第一个低补体血症点后血清C3、C4和CH50水平降低≥10%。复发的风险比（95%置信区间）对于血清C3水平为2.32（0.92-5.12），对于血清C4水平为2.46（1.18-5.01）。血清C3和C4水平的逐渐降低对预测复发具有相对较高的特异性（分别为93.3%和82.2%）但敏感性有限（分别为22.6%和41.9%）。然而，C3水平同时逐渐降低和抗双链DNA抗体水平升高具有最高的特异性（97.8%），C4水平同时逐渐降低或抗双链DNA抗体水平升高具有最高的敏感性（71.0%）。
补体水平同时逐渐降低和抗双链DNA抗体水平升高可能提示SACQ-SLE患者未来会复发。
