Study on Risk Factors for Recurrence of SLE and the Construction of Predictive Model
[Objective]To explore the recurrence of systemic lupus erythematosus(SLE)patients after stable condition through multicenter large sample data,explore the factors that affect the recurrence of SLE patients,construct predictive models and provide evidence-based medical evidence for the prevention and treatment of SLE.[Methods]From year 2020 to 2023,1 209 patients with SLE were collected from 30 hospitals across the country,and a cohort study population was established for the study of SLE.Forty-eight recurrent patients were selected as the case group,and 96 non-recurrent patients were selected as the control group in a ratio of 1:2 based on their ages and gender distribution.The survey content includesd general demographic characteristics,systemic lupus disease activity index(SLEDAI)score,traditional Chinese medicine syndrome score,Systemic Lupus International Collaborating Clinics/American College of Rheumatology(SLICC/ACR)damage index and Logistic analysis of single and multiple factors related to SLE recurrence Logistic analysis and column charts were used to construct a recurrence prediction model,and the accuracy and applicability of the model were evaluated using the receiver operating characteristic(ROC)curve calibration curve and decision curve analysis(DCA).[Results]Univariate analysis showed that SLEDAI score odds ratio(OR)=2.40,kidney injury(OR=2.39),anti U1 ribonucleoprotein(U1RNP)antibody(OR=2.90),chills and cold limbs(OR=2.90),waist and knee soreness(OR=3.95)and therapeutic medication(OR=0.45)were all influencing factors for SLE recurrence.Multivariate analysis suggested that SLEDAI score≥10(P=0.002),kidney injury(P=0.036),positive anti U1RNP antibody(P=0.047),waist and knee soreness(P=0.010),and chills and cold limbs(P=0.033)were risk factors for SLE recurrence.The use of a combination of traditional Chinese and western medicine for treatment(P=0.001)was a favorable factor in reducing recurrence.The clinical indicator prediction model area under curve(AUC)=0.699,the traditional Chinese medicine factor model AUC=0.679,and the integrated Chinese and western medicine prediction model AUC=0.786.The calibration curve and DCA curve confirm that all three models had good predictive ability and applicability.The integrated model of traditional Chinese and western medicine had more advantages.[Conclusion]SLEDAI score≥10,kidney injury,positive anti U1RNP antibody,weak waist and knees,and chills and cold limbs are the main risk factors for the recurrence of SLE.The combination of traditional Chinese and western medicine treatment is a favorable factor to reduce recurrence.The prediction model constructed based on SLEDAI score,kidney injury,anti U1RNP antibody,waist and knee soreness,chills and cold limbs and therapeutic drugs has good predictability and clinical value.
systemic lupus erythematosusrecurrencerisk factorsprediction modelcombination of Chinese traditional and western medicinenested case-control study
李霄鹏、谢志敏、张润润、赵婷、陆定其、张旭峰、杨科朋、姚心怡、朱鑫超、包洁、范永升、王新昌
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浙江中医药大学附属第二医院 杭州 310005
浙江中医药大学第二临床医学院
浙江中医药大学基础医学院
系统性红斑狼疮 复发 风险因素 预测模型 中西医结合 巢式病例对照研究
国家自然科学基金面上项目浙江省中医药现代化专项国家中医临床研究基地建设项目(第二批)Second Batch of National TCM Clinical Research Base Construction Projects
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