系统性红斑狼疮患者器官损害研究进展

发表者：黄向阳人已读

对系统性红斑狼疮患者器官损害进展及其健康相关生活质量的影响的预估

背景/目的：

描述一个纵向队列中SLE患者累积的器官损伤，并评估关键疾病相关因素，药物治疗，人口统计变量，和血清学标志物对损害发生率的影响。也对累积的器官损害和健康相关生活质量之间的关系进行了研究。

方法：

对随访长达14年的SLE患者的纵向数据库进行了分析。患者在纳入时和其后每年会进行（i）累积器官损伤（系统性红斑狼疮国际合作诊所（SLICC）/ ACR的损伤指数（SDI））及（ii）健康相关生活质量（医疗成果调查简表36（SF-36）分量表和汇总分数）的评估。使用多变量Cox比例风险模型对人口统计、疾病相关和治疗相关的因素对损伤进展的影响进行了研究。SDI分数的变化对于健康相关生活质量的影响也用线性混合效应模型进行了评估。

结果：

共有273例SLE患者的平均（SD）随访时间长达7.3（4.3）年。 77名病人（28.2％），有预先存在的损害（基线SDI> 0），在随访期间，126例（46.1％）患者SDI分数有所增高。多变量分析显示，较大的年龄、8个或更多的ACR分类标准、免疫抑制药的使用、吸烟和更高的C-反应蛋白（CRP）直至第一次SDI变化时的水平和SDI得分的增高相关联（表1）。在发生损害，并且随后与无损伤进展的患者相比，患者健康相关生活质量有变化时，SDI得分的变化与SF-36得分初始变化相关联（表2）。

结论：

通过预先存在器官损伤等一些可变危险因素，预测SLE患者额外的损害。损害进程对健康相关生活质量有负面影响，所以有必要针对可变危险因素，制定有效的预防和治疗策略，以减少器官的伤害。

关键词：生活质量和系统性红斑狼疮（SLE）

整理者：胡越

审阅者：黄向阳教授

2897 - Predictors of Organ Damage Progression and Impact on Health-Related Quality of Life in Systemic Lupus Erythematosus

Tuesday, November 10, 2015: 9:00 AM-11:00 AM

South - Halls B-C (Poster Hall) (The Moscone Center)

Presentation Number: 2897

Alexandra Legge, Dalhousie University, Halifax, NS, Steve Doucette, Dalhousie University and Capital Health, Halifax, NS and John G. Hanly, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS

Background/Purpose:

To describe cumulative organ damage in a longitudinal cohort of SLE patients and to evaluate the impact of key disease-related factors, medical therapies, demographic variables, and serological biomarkers on the rate of damage accrual. The relationship between cumulative organ damage and health-related quality of life (HRQoL) was also examined.

Methods:

A longitudinal database of SLE patients followed for up to 14 years was analyzed. Patients were assessed at enrollment and annually for (i) cumulative organ damage (Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index (SDI)) and (ii) HRQoL (Medical Outcome Survey Short Form-36 (SF-36) subscales and summary scores). The impact of demographic, disease-related and treatment-related factors on damage progression was examined using multivariable Cox proportional-hazards models. The impact of changes in SDI scores on HRQoL was assessed using linear mixed-effects modeling.

Results:

There were 273 SLE patients with a mean (SD) follow-up of 7.3 (4.3) years. Seventy-seven patients (28.2%) had preexisting damage (baseline SDI > 0) and during follow-up, 126 patients (46.1%) had an increase in SDI scores. Multivariate analysis revealed that older age, 8 or more ACR classification criteria, immunosuppressive drugs, cigarette smoking, and higher C-reactive protein (CRP) levels up to time of first SDI change were associated with an increase in SDI scores (Table 1). Changes in SDI scores were associated with initial declines in SF-36 scores at the time that damage occurred, with subsequent change in HRQoL comparable to that seen in patients without damage progression (Table 2).

Conclusion:

Pre-existing organ damage and other risk factors, some modifiable, predict additional damage accrual in SLE patients. The negative impact of damage progression on HRQoL emphasizes the need to target modifiable risk factors and develop effective prevention and treatment strategies to reduce organ damage over time.