The risk of poor response to treatment in juvenile-onset systemic lupus erythematosus patients
10.3760/cma.j.issn.1007-7480.2014.09.011
- VernacularTitle:儿童期系统性红斑狼疮疗效不佳的危险因素分析
- Author:
Lei YIN
;
Hui XIA
;
Linlin WANG
;
Wei ZHOU
- Publication Type:Journal Article
- Keywords:
Lupus erythematosus,systemic;
Risk factors;
Child
- From:
Chinese Journal of Rheumatology
2014;18(9):627-631
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors for poor response to treatment in juvenile-onset systemic lupus erythematosus (SLE).Methods The clinical manifestations,treatment and follow up data of the initial onset SLE patients in our hospital were collected retrospectively.According to the response to treatment after 6 months,patients were divided in two groups.One was treatment effective group,and the other was poor response group.The data of the two groups were analyzed by SPSS 16.0 Counted data were analyzed by Chi-square test.Measurement data were analyzed by t-test.The areas under ROC curve of the measurement data which had statistical significance were calculated and further Logistic regression analysis were made.Results In all of the 82 patients with first onset SLE,72 patients were in the treatment effective group and 10 were in the poor response group.Boy gender (5/10 & 12/72,x2=5.937,P=0.015),edema (10/10 & 25/72,x2=15.294,P＜0.O1) and serositis (8/10 & 25/72,x2=7.485,P=0.006),higher positive rate of Coombs' test (7/8 & 14/29,x2=3.931,P=0.047) and histological class Ⅳ or Ⅳ+Ⅴ of lupus nephritis (8/9 & 6/30,x2=14.278,P＜0.01) were more common in the poor response group.The level of hemoglobin (P=0.013),serum albumin (P=0.001) and globulin (P=0.004),creatinine clearance (P＜0.01),serum calcium (P=0.040) and immunoglobulin (P=0.006) of the patients in the poor efficacy group were lower than those of patients in the treatment effective group.The level of serum potassium (P=0.011),serum phosphorus (P=0.035),24 hours proteinuria (P=0.001) and SLEDAI (P=0.002) of the patients in the poor response were higher than those patients in the treatment effective group.The creatinine clearance was lower than 75.91 ml·min-1· 1.73 m-2,24 hours proteinuria was higher than 1 771.5 mg and SLEDAI was higher than 11.5 could be the diagnostic cutoff value to predict the poor response to treatment in juvenile-onset SLE patients.The results of Logistic regression analysis showed creatinine clearance lower than 75.91 ml ·min-1· 1.73 m-2 was the risk factor that could influence the outcome of SLE patients (P=0.043).The OR was 23.9 and 95％CI was from 1.10 to 516.8.Conclusion In juvenile-onset SLE patients,boys have poor response to treatment.The creatinine clearance lower than 75.91 ml·min 1· 1.73 m-2,24 hours proteinuria higher than 1 771.5 mg and SLEDAI higher than 11.5 can predict the poor response to treatment in juvenile-onset SLE patients.In addition,the SLE patients with autoimmune hemolytic anemia may have poor response to treatment.
