狼疮低疾病活动状态和缓解与高疾病活动度的系统性红斑狼疮患者器官损伤减少及病情复发的关联：一项多国纵向队列研究
Association of lupus low disease activity state and remission with reduced organ damage and flare in systemic lupus erythematosus patients with high disease activity: a multi-national, longitudinal cohort study.
作者信息
Kandane-Rathnayake Rangi, Golder Vera, Louthrenoo Worawit, Chen Yi-Hsing, Cho Jiacai, Lateef Aisha, Hamijoyo Laniyati, Luo Shue-Fen, Wu Yeong-Jian J, Navarra Sandra V, Zamora Leonid, Li Zhanguo, Sockalingam Sargunan, Katsumata Yasuhiro, Harigai Masayoshi, Hao Yanjie, Zhang Zhuoli, Basnayake B M D B, Chan Madelynn, Kikuchi Jun, Takeuchi Tsutomu, Bae Sang-Cheol, Oon Sheeran, O'Neill Sean, Goldblatt Fiona, Ng Kristine Pek Ling, Law Annie, Tugnet Nicola, Kumar Sunil, Tee Cherica, Tee Michael, Ohkubo Naoaki, Tanaka Yoshiya, Lau Chak Sing, Nikpour Mandana, Morand Eric F, Hoi Alberta
机构信息
Department of Medicine, Sub-faculty of Clinical and Molecular Medicine, Monash University, Clayton, VIC, Australia.
Department of Rheumatology, Monash Health, Clayton, VIC, Australia.
出版信息
Rheumatology (Oxford). 2025 May 1;64(5):2741-2748. doi: 10.1093/rheumatology/keae631.
OBJECTIVE
High disease activity status (HDAS) in patients with systemic lupus erythematosus (SLE) is associated with adverse long-term outcomes. We examined the frequency of lupus low disease activity state (LLDAS) and remission (REM) attainment in HDAS patients and whether their attainment was associated with improved patient outcomes.
METHODS
Demographic, clinical and outcomes data, collected prospectively from a multinational cohort between 2013 and 2020, were analysed. Disease activity was assessed using SLEDAI-2K. HDAS was defined as SLEDAI-2K ≥ 10. Patients' first visit with SLEDAI-2K ≥ 10 was assigned as baseline. Survival analyses were performed to examine the associations between cumulative and sustained LLDAS and REM attainment in HDAS patients and subsequent organ damage accrual and flare.
RESULTS
A total of 1029 HDAS patients with a median study duration of 2.7 years [IQR: 1.0, 4.8] were studied. LLDAS and REM were attained at least once by 71% (LLDAS-ever, n = 726) and 41% (REM-ever, n = 418) of patients. Approximately one-fifth of patients attained ≥50% cumulative time in LLDAS or REM. In total, 37% (n = 385) of patients attained ≥3months of sustained LLDAS, with progressively lower proportions of patients attaining longer periods of sustained LLDAS. Lower proportions of patients attained sustained REM. Attainment of cumulative and sustained LLDAS or REM provided significant protection against damage accrual and flare in HDAS patients. Sustained periods of LLDAS and REM were difficult to achieve and were therefore a more stringent target, but provided the most protection against damage accrual or flare.
CONCLUSION
LLDAS and REM were achievable targets in HDAS patients, and provided significant protection against adverse outcomes.
目的
系统性红斑狼疮（SLE）患者的高疾病活动状态（HDAS）与不良长期预后相关。我们研究了HDAS患者达到狼疮低疾病活动状态（LLDAS）和缓解（REM）的频率，以及这些状态的达成是否与患者预后改善相关。
方法
分析了2013年至2020年间从一个多国队列前瞻性收集的人口统计学、临床和预后数据。使用SLEDAI-2K评估疾病活动度。HDAS定义为SLEDAI-2K≥10。患者首次SLEDAI-2K≥10的就诊被指定为基线。进行生存分析以研究HDAS患者累积和持续达到LLDAS和REM与随后器官损伤累积及疾病活动度增加之间的关联。
结果
共研究了1029例HDAS患者，中位研究时长为2.7年[四分位间距：1.0，4.8]。71%（曾经达到LLDAS，n = 726）和41%（曾经达到REM，n = 418）的患者至少有一次达到LLDAS和REM。约五分之一的患者累积达到LLDAS或REM的时间≥50%。总共有37%（n = 385）的患者达到≥3个月的持续LLDAS，达到更长持续时间LLDAS的患者比例逐渐降低。达到持续REM的患者比例更低。累积和持续达到LLDAS或REM为HDAS患者预防损伤累积和疾病活动度增加提供了显著保护。LLDAS和REM的持续期难以实现，因此是一个更严格的目标，但对预防损伤累积或疾病活动度增加提供了最大保护。
结论
LLDAS和REM是HDAS患者可实现的目标，并为预防不良预后提供了显著保护。
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