Long-term outcomes and predictive factors of achieving low disease activity status in childhood systemic lupus erythematosus: a Chinese bicentric retrospective registered study

作者全名：Yu, Xi Xi; Deng, Jia; Chen, Qiu Xia; Qiu, Shi Yuan; Jiang, Chao Hui; Wu, Yi Qian; Yang, Qin; Zhang, Gao Fu; Yang, Hai Ping; Zhao, Fei; Li, Qiu; Zhang, Ai Hua; Wang, Mo

作者地址：[Yu, Xi Xi; Deng, Jia; Qiu, Shi Yuan; Yang, Qin; Zhang, Gao Fu; Yang, Hai Ping; Li, Qiu; Wang, Mo] Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Nephrol,Childrens Hosp, Minist Educ,Key Lab Child Dev & Disorders, Chongqing, Peoples R China; [Yu, Xi Xi; Qiu, Shi Yuan; Yang, Qin; Zhang, Gao Fu; Yang, Hai Ping; Li, Qiu; Wang, Mo] Chongqing Med Univ, China Int Sci & Technol Cooperat Base Child Dev &, Childrens Hosp, Chongqing, Peoples R China; [Deng, Jia] Chongqing Yubei Maternal & Child Hlth Hosp, Dept Pediat, Chongqing, Peoples R China; [Chen, Qiu Xia; Jiang, Chao Hui; Wu, Yi Qian; Zhao, Fei; Zhang, Ai Hua] Nanjing Med Univ, Dept Nephrol, Childrens Hosp, Nanjing, Peoples R China

通信作者：Wang, M (通讯作者)，Chongqing Med Univ, Natl Clin Res Ctr Child Hlth & Disorders, Dept Nephrol,Childrens Hosp, Minist Educ,Key Lab Child Dev & Disorders, Chongqing, Peoples R China.; Wang, M (通讯作者)，Chongqing Med Univ, China Int Sci & Technol Cooperat Base Child Dev &, Childrens Hosp, Chongqing, Peoples R China.; Zhang, AH (通讯作者)，Nanjing Med Univ, Dept Nephrol, Childrens Hosp, Nanjing, Peoples R China.

来源：FRONTIERS IN IMMUNOLOGY

ESI学科分类：IMMUNOLOGY

WOS号：WOS:001252687000001

JCR分区：Q1

影响因子：5.7

年份：2024

卷号：15

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：systemic lupus erythematosus; treat-to-target strategy; low disease activity state; predictive factors; children

摘要：Background: This study aims to explore the clinical value of low disease activity state (LDAS) in the treat-to-target strategy of pediatric systemic lupus erythematosus (pSLE) and find the risk factors for never reaching LDAS. Methods: A total of 272 children with SLE who were diagnosed and followed up in two tertiary hospitals in China during the period from January 2012 to December 2019 were involved in this study, and the clinical presentation, pathology, and treatment were retrospectively studied. Results: The male-to-female ratio was 1:5.2, the age at diagnosis was 11.1 years (IQR, 9.8-13.1 years), the disease duration was 1.0 month (IQR, 0.5-2.0 months), and follow-up was 36.5 months (IQR, 25.7-50.9 months). During follow-up, 230 children achieved LDAS, and 42 were never been in. Male (P = 0.018), mucosal ulcer (P = 0.048), liver function damage (P = 0.026), cardiac effusion (P = 0.034), anemia (P = 0.048), urine red blood cells (P = 0.017), urinary leukocytes (P = 0.032), and endothelial cell proliferation in renal biopsy (P = 0.004)-these indexes have statistical differences between the two groups in the baseline. At baseline, endothelial cell proliferation (P = 0.02) is an independent risk factor for never achieving LDAS by multivariate logistic analysis. During follow-up, non-compliance was a risk factor for never achieving LDAS by comparing between groups. Children with biologics achieved LDAS at a higher rate than children without biologics (P = 0.038). The proportion of organ damage in patients never been in LDAS was significantly higher than that in patients who achieved LDAS (P < 0.001). Conclusion: Endothelial cell proliferation in renal biopsy and non-compliance during follow-up were independent risk factors for never achieving LDAS. At the end of the follow-up, the organ damage in the remission group was similar to that in the LDAS group, indicating that LDAS can be used as a target for pSLE treatment.

基金机构：National Key Research and Development Program of China10.13039/501100012166

基金资助正文：We thank all physicians who contributed to the data by filling in the patients' medical records and all children and their families. We are grateful to Wenhao Wang from the Queen Mary University of London for the grammatical revisions.