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Title: [A cross-sectional study on application of glucocorticoid in systemic lupus erythematosus patients].
Author: Xu LL, Guo QY, Cai XY, Da ZY, Zhu HQ, Zhang LY, Su Y.
Journal: Zhonghua Nei Ke Za Zhi; 2017 Apr 01; 56(4):290-294. PubMed ID: 28355723.
Abstract:
Objective: To explore the status of glucocorticoid application in patients with systemic lupus erythematosus (SLE) in China. Methods: Epidemiological survey was used. The SLE patients who met the 1997 classification criteria of American College of Rheumatology were enrolled. The usage of glucocorticoid and related adverse reactions were recorded and analyzed. Results: A total of 400 SLE patients were enrolled, including 35 men and 365 women. The average age was (37.4±14.0) years old, and the average duration of disease was (6.7±5.8) years. There were 310 patients using glucocorticoid as maintenance. Sixty-one percent (n=244) patients started using medium dose (prednisone 30-<60 mg/d) as the initial treatment of glucocorticoid, which lasted for(37±11)days.The time of drug duration in patients with low dose prednisone (7.5-<30 mg/d)and high dose (60-100 mg/d) was(92±20)and(17±3)days respectively (P<0.05 between 3 groups). However, patients receiving different initial dosage were of no discrepancy in the maintenance therapy. During maintenance, even though 51.0% (n=158) patients were on prednisone 2.5-5 mg/d, the duration of drug use in >5-10 mg/d groupwas longer[(29.9±3.3) months]. Patients with involvement of internal organs had a higher tendency to use 60-100 mg/d prednisone or pulse-dose therapy in the initial treatment, nevertheless these two groups had no difference of maintenance dosage. Among all 400 patients, 62 patients withdrew glucocorticoid, including 17 patients with disease remission (4.3%), 44 by self-withdrawal and one with adverse reaction. Conclusion: In China, the medium dosage of glucocorticoid is the most common initial treatment in patients with SLE.Prednisone 2.5-5 mg/d was the most common choicefor maintenance therapy. Currently, the proportion of glucocorticoid withdrawal remains low in SLE patients achieving remission. 目的： 分析系统性红斑狼疮(SLE)患者糖皮质激素(以下简称激素)的使用现状，为进一步规范激素的临床应用提供依据。 方法： 采用流行病学多中心横断面便利抽样调查方法，选诊断符合1997年美国风湿病学会修订的SLE分类标准的SLE患者，分析患者激素使用情况及其相关不良反应。 结果： 共入选400例SLE患者，男性35例，女性365例，年龄(37.4±14.0)岁，病程(6.7±5.8)年，其中310例患者激素已达维持治疗。244例(61.0%)患者激素起始治疗选择中等剂量(30～<60 mg/d)泼尼松(或相当于泼尼松)，不同起始剂量间激素持续使用时间差异有统计学意义[小剂量激素7.5～<30 mg/d为(92±20)d，中等剂量激素30～<60 mg/d为(37±11)d，大剂量激素60～100 mg/d为(17±3)d, P<0.05]，激素起始剂量越大，持续使用时间越短减量越早；不同激素起始剂量间的激素维持剂量差异无统计学意义(P>0.05)。158例(51.0%)患者激素维持剂量为泼尼松(或相当于泼尼松)2.5～5 mg/d，但以>5～10 mg/d剂量维持治疗时间最长(29.9±3.3)个月。SLE患者有内脏受累者的激素起始剂量为60～100 mg/d或冲击治疗的比例明显高于无内脏受累者(P<0.001)，但两者激素维持治疗剂量差异无统计学意义(P>0.05)。400例SLE患者中62例(15.5%)患者在治疗过程中曾停用激素，其中17例(4.3%)因病情缓解停药，44例为自行停药，1例因不良反应停药。 结论： 我国使用激素治疗SLE多选择中等剂量作为起始治疗剂量，维持治疗常用剂量为泼尼松(或相当于泼尼松)每天2.5～5 mg；SLE患者病情缓解后停用激素的比例较低。.

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