Ghazali Wan Syamimee Wan, Daud Saidatul Manera Mohd, Mohammad Nurashikin, Wong Kah Keng
Department of Internal Medicine.
Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
Medicine (Baltimore). 2018 Oct;97(42):e12787. doi: 10.1097/MD.0000000000012787.
The aims of this study were to determine damage index in systemic lupus erythematosus (SLE) patients based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and to determine the laboratory and clinico-demographic factors affecting SDI.This is a retrospective cohort study of 94 SLE patients attending rheumatology clinics in 2 local hospitals in Kelantan, Malaysia. The patients were divided into 2 groups based on SDI score assigned by the attending physician, 0 (without damage) or ≥1 (with damage). Newly diagnosed SLE patients with disease duration less than 6 months were excluded.A total of 45 (47.9%) SLE patients showed damage by SDI score. Majority of the subjects had neuropsychiatric damages (21/94; 22.3%) followed by skin (12/94; 12.8%) and musculoskeletal (6/94; 6.4%) damage. SDI score was significantly associated with higher disease duration (6.2 ± 6.57 years vs 4.5 ± 3.7 years; P = .018), lower prednisolone dose (8.74 ± 10.89 mg vs 4.89 ± 3.81 mg; P < .001), hypertension (P = .007), and exposure to cyclophosphamide (P = .004). Hypertension (P = .020), exposure to cyclophosohamide (P = 0.013), and lower prednisolone dose (P = .023) were significantly associated with damage by multivariable analysis.Higher SDI score was significantly associated with exposure to cyclophosphamide, suggesting that lower cyclophosphamide doses or alternative therapeutic agents are recommended.
本研究的目的是基于系统性红斑狼疮国际协作临床中心/美国风湿病学会（SLICC/ACR）损伤指数（SDI）确定系统性红斑狼疮（SLE）患者的损伤指数，并确定影响SDI的实验室及临床人口统计学因素。这是一项对马来西亚吉兰丹2家当地医院风湿病门诊的94例SLE患者进行的回顾性队列研究。根据主治医生分配的SDI评分，将患者分为2组，0分（无损伤）或≥1分（有损伤）。排除疾病病程小于6个月的新诊断SLE患者。共有45例（47.9%）SLE患者经SDI评分显示有损伤。大多数受试者有神经精神损伤（21/94；22.3%），其次是皮肤损伤（12/94；12.8%）和肌肉骨骼损伤（6/94；6.4%）。SDI评分与更长的疾病病程（6.2±6.57年 vs 4.5±3.7年；P = 0.018）、更低的泼尼松龙剂量（8.74±10.89 mg vs 4.89±3.81 mg；P < 0.001）、高血压（P = 0.007）以及环磷酰胺暴露（P = 0.004）显著相关。多变量分析显示，高血压（P = 0.020）、环磷酰胺暴露（P = 0.013）和更低的泼尼松龙剂量（P = 0.023）与损伤显著相关。更高的SDI评分与环磷酰胺暴露显著相关，提示推荐使用更低剂量的环磷酰胺或替代治疗药物。
