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

冯丹丹; 耿晶晶; 徐亮; 袁慧

doi:10.16462/j.cnki.zhjbkz.2019.03.018

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

doi: 10.16462/j.cnki.zhjbkz.2019.03.018

冯丹丹¹,
耿晶晶¹,
徐亮^1, ,,
袁慧^2, ,

1.
241001 芜湖, 皖南医学院附属弋矶山医院风湿免疫科
2.
241002 芜湖, 皖南医学院公共卫生学院

基金项目:

安徽省自然科学基金 1608085MH219

详细信息

通讯作者:
袁慧, E-mail: yuanhui0553@163.com

徐亮, E-mail: xuliang_6657@163.com

中图分类号: R593.241
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- 文章访问数: 254
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- PDF下载量: 20
- 被引次数: 0
出版历程
- 收稿日期: 2018-05-20
- 修回日期: 2018-08-15
- 刊出日期: 2019-03-10

Rationality evaluation of predisone dosage in the treatement of SLE with different clinical scoring systems

FENG Dan-dan¹,
GENG Jing-jing¹,
XU Liang^{1
, ,},
YUAN Hui^{2
, ,}

1.
Department of Rheumatology, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
2.
School of Public Health, Wannan Medical College, Wuhu 241002, China

摘要

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。
- 系统性红斑狼疮 /
- 泼尼松 /
- 活动指数
Abstract: 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.
- Systemic lupus erythematosus /
- Prednisone /
- Scoring systems

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表 1 51例初诊SLE患者的基本情况

Table 1. Demographic and clinical variables for 51 newly diagnosed patients with SLE

初诊SLE患者(n=51)	指标值
年龄(岁)(±s)	42±12
女性(%)	82.3
病程(月)(±s)	4.0±2.7
入院时SLEDAI-2000评分(±s)	10.09±5.52
入院时BILAG-2004评分(±s)	10.58±6.71
入院时SLAM-R评分(±s)	10.80±5.04
SLE临床表现
新发皮疹(%)	40.4
蛋白尿(%)	25.5
低补体(%)	85.1
抗ds-DNA抗体滴度增高(%)	61.7
患者治疗情况
GC(%)	98
环磷酰胺(%)	8.6
吗替麦考酚酯(%)	9.7
硫酸羟氯喹(%)	100

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表 2 三种评分与初诊SLE患者泼尼松用量的相关性分析

Table 2. Correlation of three disease assessment indices with prednisone dosage

	泼尼松累计用量(mg)		泼尼松平均每日剂量(mg·d^-1)
	r值	P值	r值	P值
SLEDAI-2000	0.645	<0.001	0.584	<0.001
BILAG-2004	0.731	<0.001	0.827	<0.001
SLAM-R	0.506	<0.001	0.512	<0.001

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表 3 影响泼尼松用量的相关因素分析

Table 3. Analysis of factors associated with predisone dosage

因变量	评分系统	影响因素	β值	sx	Wald值	P值	OR(95% CI)值
泼尼松用量	SLEDAI-2000	血尿	0.544	0.187	8.414	0.004	1.722(1.139~2.487)
	SLAM-R	尿沉渣异常	1.130	0.350	10.459	0.001	3.097(1.561~6.144)
	BILAG-2004	肾脏	0.358	0.130	7.534	0.006	1.430(1.108~1.847)
大剂量激素冲击	SLEDAI-2000	管型尿	0.873	0.383	5.212	0.022	2.395(1.087~3.615)
		新发皮疹	1.209	0.560	4.659	0.031	3.350(1.132~5.609)
	SLAM-R	尿沉渣异常	1.041	0.357	7.681	0.006	2.831(1.225~5.268)
	BILAG-2004	肾脏	0.382	0.126	9.624	0.002	1.466(1.146~1.875)
		心血管/呼吸系统	0.432	0.166	6.787	0.009	1.541(1.113~2.132)

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