摘要
目的 构建多状态马尔科夫模型探讨中国系统性红斑狼疮(SLE)患者器官损伤累积的动态模式,探索不同疾病阶段器官损伤进展的可能影响因素,为优化临床治疗策略和卫生经济学评价提供依据。方法 利用中国系统性红斑狼疮研究协作组多中心注册队列(CSTAR)中满足本研究纳入标准的SLE患者作为研究对象。基于系统性红斑狼疮国际合作组/美国风湿病学会损伤指数(SDI)将SLE划分五个不可逆状态(SDI=0、1、2、≥3及死亡),分别用S0,S1,S2,S3和Death表示。利用SLE患者不同时点的诊疗数据,利用R语言“mstate”包构建多状态马尔科夫模型。结果 本研究纳入23 926例SLE患者,累计随访122 030次。基线SLE患者中20 892例患者无任何器官损伤,在随访期间内,不同器官损伤累积状态下的转移概率分别为7.01%(S0→S1), 12.58%(S1→S2), 10.64%(S2→S3)和12.19%(S3→Death)。多状态模型显示:年龄、性别、病程、平均疾病活动性指数(SLEDAI)评分、激素使用剂量、重要脏器受累情况均与器官损伤状态转移相关。不同状态间转移时年龄每增1岁,SLE患者器官损伤累积风险增加2-3%(P<0.01);神经系统受累(S0→S1:HR=1.34;S1→S2:HR=1.53;S2→S3:HR=1.73)、心肺系统受累(S0→S1:HR=3.66;S1→S2:HR=1.51;S2→S3:HR=1.52)、肾脏受累(S0→S1:HR=1.24)和血液系统受累(S0→S1:HR=1.24)可能会加速器官损伤累积。结论 SLE患者器官损伤累积的转移概率随着时间的推移逐渐增高,在疾病早期阶段尽可能减少重要脏器的受累,不同治疗阶段需动态调整治疗策略。
Objective To establish a multi-state Markov model of systemic lupus erythematosus(SLE)for patients in China and to explore the transition rule of organ damage accumulation and possible factors affecting the transition between states.Methods A retrospective cohort study was conducted using the data from CSTAR.The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index(SDI)was divided into five irreversible disease states(SDI=0,1,2,≥3,and death,marked as S0,S1,S2,S3,Death).The R“mstate”package was used for statistical analysis.Results This study included 23926 cases of SLE patients with cumulative follow-up of 12030 visits.Among these patients,21070 patients had no any organ damage at baseline.At the follow-up period,the transition probabilities of organ damage of S0→S1,S1→S2,S2→S3,S3→Death were 7.01%,12.58%,10.64%,and 12.19%,respectively.The multi-state Markov model showed that age,gender,disease duration,SLEDAI score,corticosteroid dosage,and involvement of major organs were associated with the transition of organ damage status,each 1 year increased was associated with a 2%~3%increase in risk of damage accumulation risk(P<0.01).Also,neurological(S0→S1:HR=1.34;S1→S2:HR=1.53;S2→S3:HR=1.73),cardiopulmonary(S0→S1:HR=3.66;S1→S2:HR=1.51;S2→S3:HR=1.52),renal(S0→S1:HR=1.24)and hematological involvement(S0→S1:HR=1.24)might be the risk factors.Conclusions The probability of organ damage accumulation in SLE patients increases over time.Therefore,in the early stage of the disease,the involvement of important organs needs to be minimized and the treatment strategy should be dynamically adjusted at different stages of treatment.
作者
李路
李良明
余兵
李梦涛
王艳红
LI Lu;LI Liangming;YU Bing;LI Mengtao;WANG Yanhong(Department of Epidemiology and Biostatistics,Institute of Basic Medical Sciences Chinese Academy of Medical Sciences,School of Basic Medicine Peking Union Medical College,Beijing 100005;Department of Rheumatology and Clinical Immunology,National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID),State Key Laboratory of Complex Severe and Rare Diseases,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)
出处
《基础医学与临床》
2025年第6期800-806,共7页
Basic and Clinical Medicine
基金
中国医学科学院医学与健康科技创新工程(2019-I2M-2-008)。
关键词
系统性红斑狼疮
多状态马尔科夫模型
转移概率
systemic lupus erythematosus
multi-state Markov model
transition probability
