韩国干燥综合征患者发生系统性红斑狼疮的预测因素。

Predictors for future development of systemic lupus erythematosus in Korean Sjögren's syndrome patients.

机构信息

Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

出版信息

Lupus. 2023 Oct;32(12):1359-1368. doi: 10.1177/09612033231204067. Epub 2023 Sep 26.

DOI:10.1177/09612033231204067

PMID:37751679

Abstract

OBJECTIVE

This study determined the impact of demographic factors, clinical manifestations, disease activity, and serological tests at baseline on future SLE development in Sjögren's syndrome (SS) patients.

METHODS

This retrospective study assessed 1,082 SS patients without other autoimmune diseases at baseline who visited our hospital between January 2012 and March 2021. We analyzed demographic features, extra-glandular manifestations (EGMs), clinical indices, and laboratory values at baseline between the two groups divided per future SLE development (SS/SLE group vs SS group). The probability and predictors of SLE development in SS patients were estimated using the Kaplan-Meier method and Cox proportional hazards models.

RESULTS

The median follow-up duration was 1083.5 days. Forty-nine patients (4.5%) developed SLE that met the 2012 Systemic Lupus International Collaborating Clinics or 2019 EULAR/ACR classification criteria. The baseline EULAR SS disease activity index (ESSDAI) score was significantly higher in the SS/SLE group ( < .001). The SS/SLE group had more lymphadenopathy and renal involvement ( = .015 and = .017, respectively). Shorter SS disease duration (<3 years) (hazard ratio [HR] = 2.12, = .0328), high ESSDAI (HR = 8.24, < .0001), leukopenia (HR = 4.17, = .0005), thrombocytopenia (HR = 3.38, = .0059), hypocomplementemia (HR = 29.06, <.0001), and positive for anti-dsDNA (HR = 13.70, < .0001), anti-ribonucleoprotein (RNP) (HR = 3.82, = .0027), and anti-ribosomal P (HR = 6.70, = .0002) at baseline were SLE development predictors in SS patients.

CONCLUSION

Shorter disease duration and higher disease activity of SS at baseline may be risk factors for future SLE development. Serologic predictors of SLE development are hypocomplementemia, leukopenia, thrombocytopenia, and positivity for anti-dsDNA, anti-RNP, and anti-ribosomal P antibodies. If the above factors are observed, close monitoring will be necessary during the follow-up period, considering the possibility of future SLE development.

摘要

目的

本研究旨在确定人口统计学因素、临床表现、疾病活动度和基线时的血清学检查对原发性干燥综合征（pSS）患者发生系统性红斑狼疮（SLE）的影响。

方法

本回顾性研究纳入了 2012 年 1 月至 2021 年 3 月期间在我院就诊且基线时无其他自身免疫性疾病的 1082 例 pSS 患者。我们分析了两组患者（SLE 组与 pSS 组）之间在基线时的人口统计学特征、外分泌腺表现（EGM）、临床指标和实验室值。采用 Kaplan-Meier 法和 Cox 比例风险模型估计 SS 患者发生 SLE 的概率和预测因素。

结果

中位随访时间为 1083.5 天。49 例（4.5%）患者发生了符合 2012 年系统性红斑狼疮国际协作组或 2019 年欧洲抗风湿病联盟/美国风湿病学会分类标准的 SLE。SLE 组患者的基线欧洲抗风湿病联盟 pSS 疾病活动指数（ESSDAI）评分显著较高（<0.001）。SLE 组患者的淋巴结肿大和肾脏受累更多（=0.015 和=0.017）。SS 疾病持续时间较短（<3 年）（风险比[HR]为 2.12，=0.0328）、ESSDAI 较高（HR 为 8.24，<0.0001）、白细胞减少（HR 为 4.17，=0.0005）、血小板减少（HR 为 3.38，=0.0059）、低补体血症（HR 为 29.06，<0.0001）、抗双链 DNA（HR 为 13.70，<0.0001）、抗核糖核蛋白（RNP）（HR 为 3.82，=0.0027）和抗核糖体 P（HR 为 6.70，=0.0002）抗体阳性是 SS 患者发生 SLE 的预测因素。