Department of Rheumatology and Immunology, Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, China.
Department of Rheumatology, Huai'an First People's Hospital, Huai'an, China.
Clin Rheumatol. 2022 Nov;41(11):3355-3362. doi: 10.1007/s10067-022-06289-7. Epub 2022 Jul 18.
To analyze the relative factors of improvement in disease activity (IDA) after first hospitalized treatment based on the systemic lupus erythematosus disease activity index (SLEDAI).
A total of 1069 adult systemic lupus erythematosus (SLE) patients who were hospitalized for the first time in 26 hospitals in Jiangsu Province from 1999 to 2009 were retrospectively analyzed. SLEDAI decrease ≥ 4 during hospitalization was identified as IDA. Relative factors of IDA were assessed by univariate and multivariate logistic regression.
A total of 783 (73.2%) adult SLE patients showed IDA after the first hospitalization, while the remaining patients (n = 286) were in the non-IDA group. The IDA group had higher SLEDAI at admission; fewer patients had SLICC/ACR damage index (SDI) ≥ 1, comorbidities at admission, especially Sjögren's syndrome, abnormal serum creatinine, and glomerular filtration rate. More patients had mucocutaneous and musculoskeletal involvements, leukopenia, increased C-reactive protein, anti-dsDNA antibody positive, and hypocomplementemia at admission and were treated with methotrexate and leflunomide during hospitalization. After multivariate logistic regression analysis, SDI ≥ 1 (P = 0.005) and combined with Sjögren's syndrome (P < 0.001) at admission had negative association with IDA. Musculoskeletal involvement (P < 0.001), anti-dsDNA antibody positive (P = 0.012), hypocomplementemia (P = 0.001), and use of leflunomide (P = 0.030) were significantly related with IDA.
Organ damage or comorbidities at admission were adverse to SLE improvement. Anti-dsDNA antibody positive, hypocomplementemia, musculoskeletal involvements, and leflunomide treatment had positive association with IDA of SLE. Key Points • Organ damage or comorbidities at admission were negatively correlated with SLE improvement. • Anti-dsDNA antibody positivity, hypocomplementemia, musculoskeletal involvements, and leflunomide treatment were positively associated with SLE improvement.
基于系统性红斑狼疮疾病活动指数（SLEDAI），分析首次住院治疗后疾病活动改善（IDA）的相关因素。
回顾性分析 1999 年至 2009 年江苏省 26 家医院首次住院的 1069 例成人系统性红斑狼疮（SLE）患者。住院期间 SLEDAI 下降≥4 定义为 IDA。采用单因素和多因素 logistic 回归评估 IDA 的相关因素。
共有 783 例（73.2%）成人 SLE 患者在首次住院后出现 IDA，而其余 286 例患者（n=286）为非 IDA 组。IDA 组入院时 SLEDAI 较高；入院时 SDI≥1、合并症，尤其是干燥综合征、血清肌酐异常和肾小球滤过率异常的患者较少；黏膜皮肤和肌肉骨骼受累、白细胞减少、C 反应蛋白升高、抗 dsDNA 抗体阳性和低补体血症患者较多，且住院期间接受甲氨蝶呤和来氟米特治疗。多因素 logistic 回归分析显示，SDI≥1（P=0.005）和伴有干燥综合征（P<0.001）与 IDA 呈负相关。肌肉骨骼受累（P<0.001）、抗 dsDNA 抗体阳性（P=0.012）、低补体血症（P=0.001）和使用来氟米特（P=0.030）与 SLE 的 IDA 显著相关。
入院时的器官损伤或合并症不利于 SLE 的改善。抗 dsDNA 抗体阳性、低补体血症、肌肉骨骼受累和来氟米特治疗与 SLE 的 IDA 呈正相关。
入院时的器官损伤或合并症与 SLE 改善呈负相关。
抗 dsDNA 抗体阳性、低补体血症、肌肉骨骼受累和来氟米特治疗与 SLE 改善呈正相关。
