高剂量强的松是系统性红斑狼疮患者并发抑郁症的独立危险因素

High-dose Prednisone is an Independent Risk Factor for Depression in Patients with Systemic Lupus Erythematosus

目的:用一个纵向队列观察系统性红斑狼疮(SLE)患者抑郁症的发生率,多变量模型分析评估强的松与SLE患者并发抑郁症的相关性。方法:对医院570例在入组前无抑郁症病史的SLE患者,观察并记录人口统计学变量、SLE疾病活动指数(SLEDAI)和SLE皮肤活性,伴随疾病情况及治疗情况,建立危险因素与抑郁症之间的多变量模型,分组并对每组患者进行logistic回归分析,得出调整后的关联估计值并计算抑郁症的发病率。结果:抑郁症的发病率为每1000人年有23.6次发作。在多变量分析中,目前使用强的松≥20毫克/天可独立预测SLE患者抑郁症的发生。其他SLE患者抑郁症发生的危险因素还包括:近期SLE诊断,残疾,皮肤活性。结论:SLE患者并发抑郁症是多因素的,当前使用高剂量强的松治疗可独立预测SLE患者并发抑郁症,根据强的松的独立预测效果,建议SLE临床治疗中应减少或避免激素类药物的使用。

Objective: To use a longitudinal cohort to observe the incidence of depression in patients with systemic lupus erythematosus(SLE). Also, a multivariate model was used to assess the correlation between prednisone and SLE depression. Methods: Observe and record the demographic variables, SLE Disease Activity Index(SLEDAI) and SLE cutaneous activity of 570 SLE patients who had no history of depression before cohort entry, along with disease condition and treatment condition. A multivariate model between risk factors and depression was established for patients. Logistic regression analysis was performed for each group of patients to obtain adjusted estimates of association and to calculate the incidence of depression. Results: The incidence of depression was 23.6 episodes per 1000 person-years. In multivariate analyses, prednisone ≥20 mg/day is currently used as an independent predictor of depression in SLE patients.Other risk factors for depression in SLE patients include recent diagnosis of SLE, disability, cutaneous activity. Conclusion: High dose prednisone can independently predict depression in patients with SLE. Based on the dependently predictive effect of prednisone, it is recommended that the use of hormone drugs should be reduced or avoided in the clinical treatment of SLE.