采用不同临床评分系统评估某医院狼疮激素用量的合理性分析
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摘要
目的采用系统性红斑狼疮疾病活动指数2000(systemic lupus erythematosus disease activity index 2000,SLEDAI-2000)、英国狼疮评估组指数2004(revised british Isles lupus assessment group index 2004,BILAG-2004)、系统性红斑狼疮活动性测定(systemic lupus activity measure-revised,SLAM-R)三种评分系统评估糖皮质激素(glucocorticoid,GC)在系统性红斑狼疮治疗中的规范化用量。方法收集51例初诊的系统性红斑狼疮病人的临床资料,分别应用SLEDAI-2000、BILAG-2004、SLAM-R三种评分系统判断狼疮的活动度。进行三种评分和泼尼松用量(或转换后等同的泼尼松用量)的相关性分析。结果三种评分系统均与泼尼松的累计剂量和每日剂量成正相关,其中BILAG-2004评分与泼尼松用量的相关性最好(r=0.827,P<0.001),SLAM-R评分与泼尼松用量的相关系数最低(r=0.512,P<0.001),SLEDAI-2000评分与泼尼松用量相关系数(r=0.584,P<0.001)。泼尼松的不同用法与不同的器官/系统受累有关。结论三种评分系统均可为临床上泼尼松用量的选择提供参考,但BILAG-2004评估系统更全面可靠。
Objective To evaluate the rationality of predisone dosage in the treatement of SLE with different clinical scoring systems. Methods The clinical data of 51 newly diagnosed patients with systemic lupus erythematosus(SLE) were collected, and disease activity was assessed by SLEDAI-2000, BILAG-2004 and SLAM-R scoring systems. The correlations between SLEDAI-2000, BILAG-2004, SLAM-R scores and prednisone dosage were analyzed. Results BILAG-2004 score showed the best correlation with the dosage of prednision(r=0.827, P<0.001).SLAM score showed the worst correlation with the dosage of prednision(r=0.512, P<0.001). Different treatment choice was associated with different organ/system involvement. Conclusions BILAG-2004, SLEDAI-2000 and SLAM-R scoring systems all can be used as references for the prednisone dosage slection.It is suggested that the BILAG-2004 scoring system is more reliable and comprehensive in clinical practice.
Objective To evaluate the rationality of predisone dosage in the treatement of SLE with different clinical scoring systems. Methods The clinical data of 51 newly diagnosed patients with systemic lupus erythematosus(SLE) were collected, and disease activity was assessed by SLEDAI-2000, BILAG-2004 and SLAM-R scoring systems. The correlations between SLEDAI-2000, BILAG-2004, SLAM-R scores and prednisone dosage were analyzed. Results BILAG-2004 score showed the best correlation with the dosage of prednision(r=0.827, P<0.001).SLAM score showed the worst correlation with the dosage of prednision(r=0.512, P<0.001). Different treatment choice was associated with different organ/system involvement. Conclusions BILAG-2004, SLEDAI-2000 and SLAM-R scoring systems all can be used as references for the prednisone dosage slection.It is suggested that the BILAG-2004 scoring system is more reliable and comprehensive in clinical practice.
引文
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[12] Hahn BH, Mcmahon M A, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis [J]. Arthritis Care Res(Hoboken), 2012,64(6):797-808. DOI: 10.1002/acr.21664.
[13] Ward MM, Marx AS, Barry NN. Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus [J]. J Rheumatol, 2000,27(3):664-670.
[14] Yee CS, Cresswell L, Farewell V, et al. Numerical scoring for the BILAG-2004 index [J]. Rheumatology, 2010,49(9):1665. DOI: 10.1093/rheumatology/keq026.
[15] Chang E, Abrahamowicz M, Ferland D, et al. Comparison of the responsiveness of lupus disease activity measures to changes in systemic lupus erythematosus activity relevant to patients and physicians [J]. J ClinEpidemiol, 2002,55(5):488-497.
[2] Singh JA, Hossain A, Kotb A, et al. Risk of serious infections with immunosuppressive drugs and glucocorticoids for lupus nephritis: a systematic review and network meta-analysis [J]. BMC Med, 2016,14(1):137. DOI: 10.1186/s12916-016-0673-8.
[3] Hay E, Gordon C, Emery P. Assessment of lupus: where are we now? [J]. Ann Rheum Dis, 1993, 52(3):169-172.
[4] Tsutsumi A, Ichikawa K, Atsumi T, et al. Use of various methods for anticardiolipin detection in the updated American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus: comment on the letter by Hochberg [J].Arthritis Rheum, 2010,41(7):1326-1327. DOI: 10.1002/1529-0131(199807)41:7<1326::AID-ART29>3.0.CO;2-4.
[5] Cook RJ, Gladman DD, Pericak D, et al. Prediction of short term mortality in systemic lupus erythematosus with time dependent measures of disease activity [J]. J Rheumatol, 2000,27(8):1892-1895.
[6] Bae SC, Koh HK, Chang D K, et al. Reliability and validity of systemic lupus activity measure-revised (SLAM-R) for measuring clinical disease activity in systemic lupus erythematosus [J]. Lupus, 2001,10(6):405-409. DOI: 10.1191/096120301678646146.
[7] 系统性红斑狼疮诊断及治疗指南 [J]. 中华风湿病学杂志, 2010,14(5):342-346. Guidelines for the diagnosis and treatment of systemic lupus erythematosus [J]. Chin J Rheumatol, 2010,14(5):342-346..
[8] Chang E, Abrahamowicz M, Ferland D, et al. Comparison of the responsiveness of lupus disease activity measures to changes in systemic lupus erythematosus activity relevant to patients and physicians [J]. J Clin Epidemiol, 2002, 55(5):488-497.
[9] Fatemi A, Raeisi A, Sayedbonakdar Z. Sensitivity analyses of four systemic lupus erythematosus disease activity indices in predicting the treatment changes in consecutive visits: a longitudinal study [J]. Clin Rheumatol, 2018,37(4):955-962. DOI: 10.1007/s10067-017-3949-2.
[10] 萧健萍,周强,张森,等. 可诱导共刺激分子配体在系统性红斑狼疮血清中水平及临床意义 [J]. 中华疾病控制杂志, 2016,20(10):999-1003. DOI:10.16462/j.cnki.zhjbkz.2016.10.008. Xiao JP, Zhou Q,Zhang S, et al. Serum levels and clinical significance of soluble ICOSL in patients with systemic lupus erythematosus [J]. Chin J Dis Control Prev, 2016,20(10):999-1003. DOI:10.16462/j.cnki.zhjbkz.2016.10.008.
[11] Vollenhoven RFV, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force [J]. Ann Rheum Dis, 2014,73(6):958-967. DOI: 10.1136/annrheumdis-2013-205139.
[12] Hahn BH, Mcmahon M A, Wilkinson A, et al. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis [J]. Arthritis Care Res(Hoboken), 2012,64(6):797-808. DOI: 10.1002/acr.21664.
[13] Ward MM, Marx AS, Barry NN. Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus [J]. J Rheumatol, 2000,27(3):664-670.
[14] Yee CS, Cresswell L, Farewell V, et al. Numerical scoring for the BILAG-2004 index [J]. Rheumatology, 2010,49(9):1665. DOI: 10.1093/rheumatology/keq026.
[15] Chang E, Abrahamowicz M, Ferland D, et al. Comparison of the responsiveness of lupus disease activity measures to changes in systemic lupus erythematosus activity relevant to patients and physicians [J]. J ClinEpidemiol, 2002,55(5):488-497.