系统性红斑狼疮中的神经精神事件：国际发病队列的纵向分析中发生和解决的预测因素。
Neuropsychiatric Events in Systemic Lupus Erythematosus: Predictors of Occurrence and Resolution in a Longitudinal Analysis of an International Inception Cohort.
机构信息
Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
University of Birmingham, Birmingham, UK.
出版信息
Arthritis Rheumatol. 2021 Dec;73(12):2293-2302. doi: 10.1002/art.41876. Epub 2021 Oct 29.
OBJECTIVE
To determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE).
METHODS
Upon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician-determined resolution were documented. Factors potentially associated with the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure.
RESULTS
NP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P = 0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001).
CONCLUSION
In a large and long-term study of the occurrence and resolution of NP events in SLE, we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.
目的
在一个大型的、国际性的、以系统性红斑狼疮（SLE）患者为基础的前瞻性队列中，确定神经精神（NP）事件状态变化的预测因素。
方法
在入组时和此后每年，记录归因于 SLE 和非 SLE 原因的 NP 事件以及医生确定的缓解情况。使用多状态建模结构的时间事件分析来确定与 NP 事件的发生和缓解相关的潜在因素。
结果
在 1827 名患者中的 955 名（52.3%）发生了 NP 事件，在 1910 个独特事件中 593 个（31.0%）归因于 SLE。对于与 SLE 相关的 NP（SLE NP）事件，多变量分析显示与男性性别呈正相关（P = 0.028），与非 SLE NP 事件（除外头痛）同时存在（P < 0.001），与活动期 SLE（P = 0.012）和糖皮质激素的使用（P = 0.008）呈正相关。与亚洲种族呈负相关（P = 0.002），与中学后教育（P = 0.001）和免疫抑制药物（P = 0.019）或抗疟药物（P = 0.056）的治疗呈负相关。对于非 SLE NP 事件（除外头痛），与同时存在的 SLE NP 事件呈正相关（P < 0.001），与非洲种族（P = 0.012）和亚洲种族（P < 0.001）呈负相关。归因于 SLE 的 NP 事件比非 SLE NP 事件的缓解率更高，除了头痛，头痛的缓解率相似。对于 SLE NP 事件，多变量分析显示，亚洲种族的患者（P = 0.006）和中央/局灶性 NP 事件（P < 0.001）的缓解更为常见。对于非 SLE NP 事件，非洲种族的患者缓解更为常见（P = 0.017），而 SLE 诊断时年龄较大的患者缓解更为少见（P < 0.001）。
结论
在一项关于 SLE 中 NP 事件的发生和缓解的大型长期研究中，我们确定了预后较好和较差的亚组。NP 事件的病程差异很大，取决于其性质和归因。
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