严重狼疮发作的预测因素：一项前瞻性随访研究。
Predictors of severe lupus flare: a prospective follow-up study.
作者信息
Fatemi Alimohammad, Keivani-Boroujeni Elaheh, Smiley Abbas
机构信息
Rheumatology Section, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
BMC Rheumatol. 2023 May 24;7(1):10. doi: 10.1186/s41927-023-00333-y.
BACKGROUND
Flare-up of systemic lupus erythematosus (SLE) is a common characteristic that could have deleterious effects on patients' outcome and survival. The aim of this study was to identify the predictors of severe lupus flare.
METHODS
120 patients with SLE were enrolled and followed-up for 23 months. Demographic, clinical manifestations, laboratory parameters and disease activity were recorded at each visit. In addition, presence of severe lupus flare at each visit was evaluated by using the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLE disease activity index (SLEDAI) flare composite index. Predictors of severe lupus flare were obtained by backward logistic regression analyses. Predictors of SLEDAI were obtained by backward linear regression analyses.
RESULTS
During the follow-up period, 47 patients had at least one episode of severe lupus flare. Mean (SD) age of patients with severe flare versus no flare was 31.7 (7.89) and 38.3 (8.24) years, respectively (P = 0.001). Ten (62.5%) out of 16 males and 37 (35.5%) out of 104 females had severe flare (P = 0.04). History of lupus nephritis (LN) was recorded in 76.5% and 44% of patients with severe flare and no severe flare, respectively (P = 0.001). Thirty-five (29.2%) patients with high anti-double-stranded DNA (anti-ds-DNA antibody) and 12 (10%) with negative anti-ds-DNA antibody had severe lupus flare (P = 0.02). By multivariable logistic regression analysis, younger age (OR = 0.87, 95% CI 0.80-0.94, P = 0.0001), history of LN (OR = 4.66, 95% CI 1.55-14.002, P = 0.006) and high SLEDAI at the first visit (OR = 1.19, 95% CI 1.026-1.38) were the main predictors of flare. When severe lupus flare after the first visit was used as the outcome variable, similar findings were observed but, SLEDAI, although left among the final predictors in the model, was not significant. SLEDAIs in future visits were mainly predicted by Anti-ds-DNA antibody, 24-h urine protein and arthritis at the first visit.
CONCLUSION
SLE patients with younger age, history of previous LN or high baseline SLEDAI, may need closer monitoring and follow up.
背景
系统性红斑狼疮（SLE）病情复发是一个常见特征，可能对患者的预后和生存产生有害影响。本研究的目的是确定严重狼疮病情复发的预测因素。
方法
纳入120例SLE患者并随访23个月。每次就诊时记录人口统计学信息、临床表现、实验室参数和疾病活动情况。此外，采用狼疮性红斑中雌激素安全性全国评估（SELENA）-SLE疾病活动指数（SLEDAI）病情复发综合指数评估每次就诊时严重狼疮病情复发的情况。通过向后逻辑回归分析获得严重狼疮病情复发的预测因素。通过向后线性回归分析获得SLEDAI的预测因素。
结果
在随访期间，47例患者至少有一次严重狼疮病情复发。有严重病情复发的患者与无病情复发的患者的平均（标准差）年龄分别为31.7（7.89）岁和38.3（8.24）岁（P = 0.001）。16例男性中有10例（62.5%）、104例女性中有37例（35.5%）有严重病情复发（P = 0.04）。有狼疮肾炎（LN）病史的患者在有严重病情复发的患者和无严重病情复发的患者中分别占76.5%和44%（P = 0.001）。35例（29.2%）抗双链DNA（抗ds-DNA抗体）水平高的患者和12例（10%）抗ds-DNA抗体阴性的患者有严重狼疮病情复发（P = 0.02）。通过多变量逻辑回归分析，年龄较小（比值比[OR]=0.87，95%置信区间[CI] 0.80 - 0.94，P = 0.0001）、LN病史（OR = 4.66，95% CI 1.55 - 14.002，P = 0.006）以及首次就诊时SLEDAI水平高（OR = 1.19，95% CI 1.026 - 1.38）是病情复发的主要预测因素。当将首次就诊后严重狼疮病情复发作为结果变量时，观察到类似结果，不过，SLEDAI虽然仍在模型的最终预测因素中，但并不显著。未来就诊时的SLEDAI主要由首次就诊时的抗ds-DNA抗体、24小时尿蛋白和关节炎预测。
结论
年龄较小、既往有LN病史或基线SLEDAI水平高的SLE患者可能需要更密切的监测和随访。
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