Low C4 as a risk factor for severe neuropsychiatric flare in patients with systemic lupus erythematosus
Low C4 as a risk factor for severe neuropsychiatric flare in patients with systemic lupus erythematosus
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DOI：
10.1177/0961203320938453
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发表时间：
2020-07-07
期刊：
影响因子：
2.6
通讯作者：
Atsumi, Tatsuya
中科院分区：
文献类型：
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作者：
Aso, Kuniyuki;Kono, Michihito;Atsumi, Tatsuya
目的探讨系统性红斑狼疮（SLE）患者发生“重度”神经精神（NP）发作的危险因素。方法本回顾性研究包括2006年至2017年期间在北海道大学医院就诊的184例新诊断的成人SLE患者。在本研究中，重度NP发作定义为在神经系统领域出现至少一个新开发的不列颠群岛狼疮评估A组评分。通过Kaplan-Meier分析估计总体重度NP无复发生存期。在校正的多变量考克斯回归模型中，SLE诊断时的临床和人口统计学特征被评估为潜在风险项。结果中位随访时间为7.9年（四分位距（IQR）4.6-12.3）年。在观察期内，共有28例（15.2%）患者发生1次或多次重度NP发作。从患者入组日期至重度NP发作发生的中位时间为3.1年（IQR 0.9-6.3年）。2年和10年重症NP无复发生存率分别为92.7%和86.0%。在严重的NP发作的表现中，精神病是最常见的（19.1%）。在多变量模型中，低血清C4水平（HR = 3.67，p = 0.013）和SLE诊断时的严重NP表现（HR = 7.11，p < 0.001）是发生严重NP发作的独立危险因素。结论首次严重的NP发作出现在SLE病程早期。SLE诊断时低C4水平和严重的NP表现可预测严重NP发作的发展。
Objective This study aimed to explore the risk factors for 'severe' neuropsychiatric (NP) flare in patients with systemic lupus erythematosus (SLE). Methods This retrospective study comprised newly diagnosed 184 adult SLE patients who visited Hokkaido University Hospital between 2006 and 2017. In this study, severe NP flare was defined as the occurrence of at least one newly developed British Isles Lupus Assessment Group A score in the neurological domain. Overall severe NP flare-free survival was estimated by Kaplan-Meier analysis. Clinical and demographic profiles at SLE diagnosis were assessed as potential risk items in the adjusted multivariate Cox regression model. Results The median follow-up period was 7.9 years (interquartile range (IQR) 4.6-12.3) years. A total of 28 (15.2%) patients had one or more severe NP flares during the observation period. The median time from patient enrolment date to severe NP flare occurrence was 3.1 years (IQR 0.9-6.3 year). The 2- and 10-year severe NP flare-free survival rates were 92.7% and 86.0%, respectively. Among the manifestations of severe NP flare, psychosis was the most frequent (19.1%). In the multivariate model, low serum levels of C4 (hazard ratio (HR) = 3.67,p = 0.013) and severe NP manifestations at SLE diagnosis (HR = 7.11,p < 0.001) emerged as independent risk factors for developing severe NP flare. Conclusion The first severe NP flare presented early in the course of SLE. Low C4 level and severe NP manifestations at SLE diagnosis could predict the development of severe NP flare.