《上海仁济的讲义的资料关于SL的讲义课件》由会员分享，可在线阅读，更多相关《上海仁济的讲义的资料关于SL的讲义课件（53页珍藏版）》请在金锄头文库上搜索。
1、SLE- A Controllable, Remittable, Inflammatory Autoimmune Disease:Data From a Long Term Follow-up Study of 1072 Lupus Patients, Shanghai RJH Shunle Chen Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaBackground Prognosis of lupus patients h
2、as been dramaticly improved during past decadesThousands of SLE patients has been registered in clinic database of Dept. of Rheumatology, Shanghai Renji Hospital since 1979To clarify the long-term outcome of Chinese SLE patients , a study was carried on Renji Hospital Lupus Cohort. Objectives i) dem
3、ographic data and quality of lifeii) morbidity and mortality rate iii) main causes of deathPatients (Totally 1072 pts followed by Dr.Shunle Chen in his clinic)Mean Age： 38.6 (9-78) yrsDisease duration:Gender：M 64 (6%), F 1008 (94%)10 y10-20 y20-3)219 (20.4%) Stable(SLEDAI3) 756(70.6%) Died 97(9%)Cau
4、se of Death (N=97)No gender difference Male: 8 ( 8.25%)Female: 89 (8.08%)Main Causes of deathsevere infection：22.7%cardio-cerebral vascular events：14.4%renal failure：13.4%SLE active: 4.1%Others: lymphoma, hepatic coma, PAH, ILD, etc.ThePrednisoneusageofthosestablePts(N=756)52 pts with drug withdrawa
5、l average 6.9 yrsDuration of drug withdrawThestablePtswithlowdoseofPrednisone(N=469)10mg,469 cases =10mg,197 cases7.5mg, 272 cases=7.5mg, 99 cases=5mg, 113 cases5mg, 8 casesDiseasedoesnotaffectthosepatientstoreceivethehigheducationEmploymentstatusofSLEptsUnknown, 1(0%)Employed, 610(57%)Unemployed, 5
6、4(5%)Sick leave, 121(11%)Retired, 175(16%)Housekeeping, 111(11%)SLEPatientstendtohavestablemarriageMaritalFertilityRateofSLEpts(N=760) Pregnancy is no more a contraindication for SLE patients under supervision of both rheumatologist and obstetricianBirth, 555(73%)Unknown, 51( 7%)No birth, 153(20%)Ho
7、w happy they are!The difference of SF-36 between patients with or without organ involvementSome domains in SF-36 are worse on those patients with organ involvement.*：P0.01*:P0.05SF-36scoresinpatientsgroupedaccordingtodifferentincomelevelsQOL positively correlated with personal income levels*：P0.01*:
8、P0.05SF-36scoresinpatientsgroupedaccordingtodifferenteducationallevelsThe higher level of education, the higher quality of life *：P0.05Out ScoreA comparison of infection rate in 2 groups(7/30)(22/30)Infection rateSkin(25%)Respiratory tract(75%)The site of infection in the therapy of 2 groups(P0.01)S
9、tage II: prospective study GroupA*: P.M.C group N=42 Prednisone 10mg/d (0.2mg/kg/d) + MTX 10mg/w + Chloroquine 0.25g/d GroupB* : controlled group N=20 Prednisone 0.5mg/kg/d * six month course A comparison of efficacy (SLEDAI score) between two groups*P0.05Control groupComparison of weight gaining be
10、tween two groupsControl group*P0.05Comparison of infection rate between two groupsControl group*P0.05The site of infection in the 2 groupsSkin 30%Respiratory tract62%Urinary tract 8%Comparisons of TG ,Cho,Glucose, Bone Density changes before and after therapy between two groups TG*ChoGlucose*Bone de
11、nsity*P0.05关于抗疟药治疗狼疮的新观点羟氯喹的重要性越来越受关注，是一个很重要的狼疮病情改变药，它具有抗凝、降脂、减少激素用量和副反应的作用，发生视网膜病变的几率低。一项研究表明，133名服用羟氯喹的孕妇，其成功妊娠的比率为88%（对照组为84%），对出生后的婴儿随访108个月，未发现视、听觉及生长发育的异常。但在FDA妊娠用药分类仍属C类 。 Nathalie Costedoat-Chalumeau. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases . Arthrit
12、is & Rheumatism 2003,48(11)3207-12关于MTX在狼疮治疗中的应用MTX治疗狼疮再次引起重视，MTX除了免疫抑制作用外，还具有多重抗炎作用，可增加炎症部位的腺苷水平、抑制白三烯形成及抑制Cox-2 。它可减低SLEDAI积分，减少激素用量。临床试验证实MTX对狼疮的关节炎、皮疹、浆膜炎、白细胞破粹性血管炎有较好疗效。目前尚无引起狼疮病人肺部毒性的报道。Lupus(4th Ed). 2004. Robert G. Lahita靶向治疗 对狼疮的免疫学发病机制,尤其是免疫调节通路的深入研究,促使靶向治疗成为可能。SLE治疗的靶点S Vasso and GRV Hugh
13、es. Lupus (2005) 14,181-188 anti-CD40L antibodies CTLA-4IgBiological agents B7-1 mAbsT/B T/B cell interactionB 细胞靶向治疗抗 CD20 单抗 (Rituximab)：作用于B细胞表面的CD20抗原，选择性耗尽B细胞。效果好，无严重副反应，包括感染。有相当病人产生HACAs（人抗嵌合体型抗体）：使Rituximab水平降低，减少B细胞耗尽， SLAM积分提高， 多见于美国黑人SLE。抗 CD22 单抗 (epratuzumab)与CD20不同，选择性抑制活化B细胞。全球 III期临床试
14、验正开展。B 细胞靶向治疗抗BLyS （B淋巴细胞刺激剂）抑制B细胞存活（Survival）。动物模型显示BlyS表达过高可致狼疮病变，祛除BlyS则可消除SLE。临床和血清学的效果尚待验证。 无明显副作用。B细胞耐受原(LJP-934) 为人工合成分子，可交联B细胞表面的抗dsDNA抗体，诱导免疫耐受。 延迟肾炎的发作，降低dsDNA抗体的滴度。无明显副作用。T 细胞靶向治疗抗CD40L单抗（ruplizumab）由于增加血栓栓塞事件，临床试验已被终止。CTLA-4Ig系一可溶性受体，能阻断CD28-B7共刺激T 细胞激活途径。II/III期临床试验阶段，初步效果良好。副作用少。随着生物靶向
15、性治疗的兴起，使SLE的治疗策略已进入一个新时代，上述资料显示生物学治疗可能更靶向地抑制免疫，以避免或减轻SLE传统治疗的毒性。很显然要确切了解该疗法的疗效、安全性以及代价有效性，尚待进行大量工作。 The outcome of SLE patients in our cohort improved dramatically, long-term or possibly permanent remission could be obtained in lupus patients to a large extent.Our goal for treatment: H C P quality of lifeH C PAcknowledgeDepartment of Rheumatology, Renji Hospital Chunde Bao Liangjing Lu Yu Lu Hui Du Sheng Chen Ting Li Ping Ye Shuiying Li Xianmin Hu Jin ZhuDivision of Epidemic and Health Statistics, Shanghai Jiaotong University Binghua Su Chaohui Wei
