目的:系统性红斑狼疮(SLE)患者预后不良的主要决定因素在于不可逆的器官损害。这项前瞻性队列研究旨在确定抗核小体抗体对SLE患者器官损伤积累的附加价值。
方法:基于中国SLE治疗和研究组(CSTAR)注册,人口特征,自身抗体谱,在基线时收集临床表现。通过回顾临床记录收集随访数据。
结果:在2481例SLE患者中,有完整的随访数据,663(26.7%)是抗核小体抗体阳性,1668(68.0%)是抗dsDNA抗体阳性。在平均4.31±2.60年的随访中,764例(30.8%)患者出现了新的器官损伤。在基线,抗核小体抗体阳性的患者狼疮性肾炎的发生率较高(50.7%vs36.2%,p<.001)。根据多变量Cox回归分析,抗核小体(HR=1.30,95%CI,1.09-1.54,p<.001)和抗dsDNA抗体(HR=1.68,95%CI,1.38-2.05,p<.001)均与器官损伤累积相关。抗核小体(HR=2.51,95%CI,1.81-3.46,p<.001)和抗dsDNA抗体(HR=1.69,95%CI,1.39-2.06,p<.001)是肾损害的独立预测因子。此外,两种抗体的组合可以提供关于整体SLE患者(HR=3.19,95%CI,2.49-4.10,p<.001)和基线狼疮性肾炎患者(HR=2.86,95%CI,2.29-3.57,p<.001)肾损害的更准确信息.
结论:除了抗dsDNA抗体,抗核小体抗体还可以提供随访期间器官损害发生的相关信息.抗核小体和抗dsDNA抗体在预测肾损伤中的共阳性能力可能在这些患者的随访中带来额外的益处。
OBJECTIVE: The predominant determinant of an unfavorable prognosis among Systemic Lupus Erythematosus (SLE) patients resides in the irreversible organ damage. This prospective cohort study aimed to identify the additional value of anti-nucleosome antibodies on organ damage accumulation in SLE patients.
METHODS: Based on the Chinese SLE Treatment and Research group (CSTAR) registry, demographic characteristics, autoantibodies profiles, and clinical manifestations were collected at baseline. Follow-up data were collected by reviewing clinical records.
RESULTS: Of 2481 SLE patients with full follow-up data, 663 (26.7%) were anti-nucleosome antibodies positive and 1668 (68.0%) were anti-dsDNA antibodies positive. 764 (30.8%) patients developed new organ damage during a mean follow-up of 4.31 ± 2.60 years. At baseline, patients with positive anti-nucleosome antibodies have a higher rate of lupus nephritis (50.7% vs 36.2%, p < .001). According to the multivariable Cox regression analysis, both anti-nucleosome (HR = 1.30, 95% CI, 1.09-1.54, p < .001) and anti-dsDNA antibodies (HR=1.68, 95% CI, 1.38-2.05, p < .001) were associated with organ damage accumulation. Anti-nucleosome (HR = 2.51, 95% CI, 1.81-3.46, p < .001) and anti-dsDNA antibodies (HR = 1.69, 95% CI, 1.39-2.06, p < .001) were independent predictors for renal damage. Furthermore, the combination of the two antibodies can provide more accurate information about renal damage in overall SLE patients (HR = 3.19, 95% CI, 2.49-4.10, p < .001) and patients with lupus nephritis at baseline (HR = 2.86, 95% CI, 2.29-3.57, p < .001).
CONCLUSIONS: Besides anti-dsDNA antibodies, anti-nucleosome antibodies can also provide information about organ damage accrual during follow-up. The ability of co-positivity of anti-nucleosome and anti-dsDNA antibodies in predicting renal damage may lead to additional benefits in the follow-up of these patients.