羟氯喹对系统性红斑狼疮患者感染的保护作用：使用 LUNA 登记研究的观察性研究。

Protective effect of hydroxychloroquine on infections in patients with systemic lupus erythematosus: an observational study using the LUNA registry.

机构信息

Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Clinical Laboratory Department, Yokohama City University Hospital, Yokohama, Japan.

出版信息

Front Immunol. 2023 Sep 1;14:1227403. doi: 10.3389/fimmu.2023.1227403. eCollection 2023.

DOI:10.3389/fimmu.2023.1227403

PMID:37720209

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10504661/

Abstract

OBJECTIVES

Infection is a leading cause of death in patients with systemic lupus erythematosus (SLE). Alt hough hydroxychloroquine (HCQ) has been reported to inhibit infection, evidence from Asian populations remains insufficient. We investigated this effect in Japanese SLE patients.

METHODS

Data from the Lupus Registry of Nationwide Institutions were used in this study. The patients were ≥20 years old and met the American College of Rheumatology (ACR) classification criteria revised in 1997. We defined "severe infections" as those requiring hospitalization. We analyzed the HCQ's effect on infection suppression using a generalized estimating equation (GEE) logistic regression model as the primary endpoint and performed a survival analysis for the duration until the first severe infection.

RESULTS

Data from 925 patients were used (median age, 45 [interquartile range 35-57] years; female, 88.1%). GEE analysis revealed that severe infections were significantly associated with glucocorticoid dose (odds ratio [OR] 1.968 [95% confidence interval, 1.379-2.810], <0.001), immunosuppressants (OR 1.561 [1.025-2.380], =0.038), and baseline age (OR 1.043 [1.027-1.060], <0.001). HCQ tended to suppress severe infections, although not significantly (OR 0.590 [0.329-1.058], =0.077). Survival time analysis revealed a lower incidence of severe infections in the HCQ group than in the non-HCQ group (<0.001). In a Cox proportional hazards model, baseline age (hazard ratio [HR] 1.029 [1.009-1.050], =0.005) and HCQ (HR 0.322 [0.142-0.728], =0.006) were significantly related to incidence.

CONCLUSION

HCQ may help extend the time until the occurrence of infection complications and tends to decrease infection rates.

摘要

目的

感染是系统性红斑狼疮（SLE）患者死亡的主要原因。虽然羟氯喹（HCQ）已被报道可抑制感染，但来自亚洲人群的证据仍不充分。我们在日本 SLE 患者中对此进行了研究。

方法

本研究使用了全国机构狼疮登记处的数据。患者年龄≥20 岁，符合 1997 年修订的美国风湿病学会（ACR）分类标准。我们将“严重感染”定义为需要住院治疗的感染。我们使用广义估计方程（GEE）逻辑回归模型作为主要终点分析 HCQ 对感染抑制的作用，并对首次严重感染的持续时间进行生存分析。

结果

使用了 925 例患者的数据（中位年龄 45[四分位间距 35-57]岁；女性占 88.1%）。GEE 分析显示，严重感染与糖皮质激素剂量（比值比[OR] 1.968[95%置信区间，1.379-2.810]，<0.001）、免疫抑制剂（OR 1.561[1.025-2.380]，=0.038）和基线年龄（OR 1.043[1.027-1.060]，<0.001）显著相关。尽管不显著，但 HCQ 似乎抑制了严重感染（OR 0.590[0.329-1.058]，=0.077）。生存时间分析显示，HCQ 组严重感染的发生率低于非 HCQ 组（<0.001）。在 Cox 比例风险模型中，基线年龄（风险比[HR] 1.029[1.009-1.050]，=0.005）和 HCQ（HR 0.322[0.142-0.728]，=0.006）与发生率显著相关。