中国系统性红斑狼疮的诊治现状及挑战

Current status and challenges in diagnosis and treatment of systemic lupus erythematosus in China

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种以多系统损害为特征的自身免疫性疾病。我国SLE患者基数大、病情重、缓解率低、复发率高、感染风险高。2023年,研究显示,全球有SLE患者约341万例,其中我国患者达70~100万例,总数位居首位。我国SLE患者的平均发病年龄为30.7岁,女性与男性的发病比为12∶1;脏器受累更为多见,其中肾脏受累率为45.02%,血液系统受累率为37.2%,均显著高于欧洲SLE患者(肾脏受累率为27.9%,血液系统受累率为18.2%)。我国SLE患者疾病治疗的临床缓解率为2.47%,而国际报道的缓解率达22.9%。当前,我国SLE患者的短期生存率基本与国际一致(5年可达94%),但长期生存率仍不容乐观,呈断崖式下跌,25~30年生存率仅为30%。我国有84.13%的SLE患者使用糖皮质激素治疗,而国际上SLE患者的糖皮质激素使用率仅为42.6%,感染是我国SLE患者死亡的首位原因,而西方国家SLE患者死因则主要为心血管疾病和肿瘤。随着新分类标准的提出、达标治疗理念的引入、新型治疗方法的运用,将大大推动SLE诊疗的发展,有望进一步改善我国患者的预后。

Systemic lupus erythematosus(SLE)is an autoimmune disease characterized by multiple system involvements.The number of SLE patients in China is large,and patients suffer more severe condition,with low remission rate,high recurrence rate,and high risk of infection.The situation of diagnosis and treatment for SLE is still serious.Relevant research released in 2023 shows that there are about 3.41 million cases of SLE patients in the world,and the number of patients in China amounts to 700000-1000000,ranking the first in the world.The average onset age of SLE patients in China is 30.7 years old,and the incidence ratio of women to men is 12∶1.Organ involvement is more common in China,with 45.02%of renal involvement and 37.2%of haematological involvement,which are significantly higher than those in European patients with SLE(27.9%of renal involvement and 18.2%of haematological involvement).The clinical remission rate of SLE patients in China is 2.47%,while the relief rate reported internationally is 22.9%.Currently,the short-term survival rate of SLE patients in China is basically in line with that in the world(5-year survival rate reach 94%),but the long-term survival rate is still not optimistic,declining sharply,with a 25-30 year survival rate of only 30%.In China,84.13%of SLE patients receive glucocorticoid(GC)therapy,while 42.6%SLE patients receive GC in the world.Infection is the leading cause of death for SLE patients in China,while in western countries,the main causes of death for SLE patients are cardiovascular disease and tumors With the proposal of new classification standards,the introduction of the concept of up-to-date treatment,as well as the use of new treatment methods,the development of SLE diagnosis and treatment will be greatly promoted,and it is expected to further improve the prognosis of patients in China.