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How to Treat Systemic Lupus Erythematosus: Interpretation of 2019 Update of the EULAR Recommendations for the Management of Systemic Lupus Erythematosus
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摘要: 《2019年欧洲抗风湿病联盟系统性红斑狼疮管理指南》是欧洲抗风湿病联盟自2007年以来,第二次针对系统性红斑狼疮(systemic lupus erthymatosus,SLE)整体管理制定的指南。该指南对SLE的治疗策略、治疗目标、激素方案选择、狼疮性肾炎"多靶点"治疗以及生物制剂应用等内容进行了更新,在达标治疗的大趋势下,为SLE如此复杂的疾病,指明了治疗方向。本文对指南更新内容进行详细解读,以期为SLE临床诊治提供借鉴。Abstract: 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus is the second edition that EULAR has developed for the general management of systemic lupus erythematosus (SLE) since 2007. The treatment strategy, validated goals of treatment, alternative regimens of glucocorticoids, "multi-targeted" therapy in lupus nephritis, and biological therapy for SLE were updated in the recommendations, which indicated the direction for the treatment of SLE. A detailed interpretation of the updated guidelines is provided in this article, aiming to provide references for the clinical diagnosis and treatment of SLE.
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Key words:
- systemic lupus erythematosus /
- recommendation /
- treat to target
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表 1 2019年EULAR指南缓解及低疾病活动度标准与DORIS比较
指标 2019年EULAR指南 DORIS 完全缓解 低疾病活动度 停药缓解 带药缓解 SLEDA 0分 ≤4 临床项目评分为0 临床项目评分为0 PGA － ≤1 PGA≤0.5 PGA≤0.5 其他疾病活动度评分 － － BILAG-2004评分为D/E, 临床ECLAM评分为0 BILAG-2004评分为D/E, 临床ECLAM评分为0 激素 停用 强的松≤7.5mg 停用 强的松≤5mg 抗疟药 可使用 可使用 可使用 可使用 免疫抑制剂 停用 稳定剂量 停用 稳定剂量 生物制剂 － － 停用 稳定剂量 EULAR:欧洲抗风湿病联盟, DORIS:系统性红斑狼疮缓解期定义, SLEDAI:系统性红斑狼疮疾病活动指数, PGA:医生整体评估, BILAG:不列颠群岛狼疮评估小组评分, ECLAM:欧洲共识疾病活动度评估, －:指南未规定 
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表 2 2019年EULAR指南狼疮性肾炎缓解定义与2012年EULAR/ERA-EDTA指南比较
2019年EULAR指南 2019年EULAR指南 完全缓解 部分缓解 完全缓解 部分缓解 尿蛋白 ＜0.5g/24h 下降50%以上且小于35g/24h 尿蛋白/肌酐＜50mg/ mmol 下降50%以上且小于35g/24h 肾功能 Scr升高不超过基线的10% GFR下降不超过正常的10% 达标时间 12~24个月 6~12个月 － 6~12个月 EULAR:同表1，ERAEDTA:欧洲肾脏学会-欧洲透析和移植学会, Scr:肌酐, GFR:肾小球滤过率, －:指南未规定
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