2020中国系统性红斑狼疮诊疗指南 - chenjumei.com

1 172 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3.. 2020 .. 100730 Email . SLE . SLE .. grading of recommendations assessment development and evaluation GRADE RIGHT . 12 SLE .. 2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus Chinese Rheumatology Association, National Clinical Research Center for Dermatologic and Immunologic Diseases,Chinese Systemic Lupus Erythematosus Treatment and Research Group Corresponding author: Zeng Xiaofeng, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China.

2 Email: Summary Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. In 2019, under the leadership of the Chinese Rheumatology Association, a multidisciplinary guideline development group was established. The objective was to develop an evidence based diagnosis and treatment guideline for SLE in China based on emerging new evidence. The guideline was registered at International Practice Guidelines Registry Platform (IPGRP 2019CN022). The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations, and the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was followed to report the guideline.

3 The guideline provides recommendations for the SLE classification criteria, disease activity monitoring and assessing, medication principles and considerations organ and system involvement and management of patients during pregnancy. This guideline is intended to serve as a tool for Chinese clinicians for the best decisions making on diagnosis and treatment of SLE. Key words Lupus erythematosus, systemic; Guideline; GRADE. systemic lupus erythematosus SLE SLE . SLE 5 20 50 50%~60%. 90 90% 2008 2016 . 5 95% 5 . SLE 92% . 9 11 . SLE . 1 3 SLE SLE . SLE 0~241/10 SLE . 30~70/10 1 10~12. 4 5 . SLE. 6 8 . EULAR BSR . 2020 3 59 3 Chin J Intern Med March 2020, Vol.

4 59, No. 3 173 . PANLAR 30 . SLE . 12 14 . 83 . 2010 12 . 15 . 6.. Population . SLE Intervention Comparison and Outcome PICO . 1 Chinese Lupus 1 MEDLINE Cochrane . Treatment and Research Group CSTAR Library Epistemonikos . SLE . 6 16 17 . Meta Meta 2 SLE . 2019 9 . 2 UpToDate . DynaMed MEDLINE . 3 2010 .. 2019 9 . 3 . NICE SIGN . SLE ACR EULAR APLAR . MEDLINE SLE . CSTAR 4 Google .. 2020 7.. A Measurement Tool to Assess systematic Reviews AMSTAR . 23 . Meta . Meta Cochrane . 24 Risk of Bias ROB . 1. 25 Quality Assessment of Diagnostic Accuracy Studies QUADAS 2 . CSTAR 2019 3 21 Newcastle Ottawa Scale . 26 . 2020 1 21 NOS . 2.

5 / Grading of Recommendations Assessment . GRADE Development and Evaluation GRADE . 27 31 1 . 3.. 1 . International Practice Guidelines Registry Platform .. http //www. guidelines registry. org .. IPGRP 2019CN022 . A . 2014 . 18 .. B . 2016 / < > .. 19 . Appraisal of C . Guidelines for Research and Evaluation AGREE . 20 Reporting Items for Practice D .. Guidelines in Healthcare RIGHT . 21 22 .. 4.. 1 .. 2 . SLE . SLE . 5. SLE 8.. 174 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3.. 2019 10 5 2019 11 8 1C . 98 . 2019 11 2020 1 . 9. 3~5 38 SLE .. 32 .. 1 . SLE 12 13 15 . 1 2012 SLE . SLICC 2019 EULAR/ACR SLE . SLE 1B 39.

6 4 SLE 25% .. / 2C 45% SLE . SLE 2019 SLE 4 60% 40 . EULAR ACR 1997 ACR SLE . 2019 EULAR/ACR SLE . 1 10 18 .. 10 SLE . SLE 33 2019 HR= 95%CI ~ . EULAR/ACR 2012 SLICC 1997 ACR SLE HR= 95%CI ~ SLE . 96% 97% 83% 93% 84% 41 . 93% 2019 EULAR/ACR SLE SLE. SLE . 2019 EULAR/ACR 2012 SLICC 3 SLE . 1997 ACR SLE 93% 100% . 73% 75% 82% SLE 3 SLE . 2012 SLICC 33 34 SLE SLEDAI 2000 . SLE 2C . SLEDAI 2000 . SLE 1997 ACR SLE SLEDAI 2000 6 SLEDAI 2000 7~12 . SLE SLEDAI 2000>12 2D . SLE 35 36 SLE 1 1 2C . SLE 2012 SLICC 2019 EULAR/ACR SLE 3~6 1 . SLE . 71 2D . SLE 23% 1997 ACR SLE SLE 7 42 49 . 4 4 . 249 SLE 79% 1997 ACR . SLE 4 4 37 . 50 . SLE SLEDAI 2000.

7 BILAG 2004 . 2 SLE SLEDAI 2000 0~105 BILAG 2004 A . 2 SLE B C D E 5 BILAG 2004 . 1C SLE SLEDAI 2000 . 1C . 51 . SLEDAI 2000 . 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3 175 . 4 SLE . EULAR . 12 13 15 52 .. SLEDAI 2000 6 . SLEDAI 2000 7~12 SLEDAI 2000>12 12 .. SLEDAI 2000 HR= SLE . 95%CI ~ HR= 95%CI ~ . SLE . 38 . 10 mg/d . SLEDAI 2000 BILAG 2004 12 13 15 53 56 57 . SLE ~. physician global assessment PGA 1 mg kg-1 d-1 . SLE SLE . SLE . SLE SLE 1~3 13 15 56 . 1 SLE SLE 1mg . 1 3~4 1 kg d-1 . -1. SLE SLE 15 56 . 6~12 1 13 53 SLE 12 53 57 . SLE 1 1 SLE . 3~6 1 . SLE 500~1 000 mg/d 3 d 5~. SDI SLE 30 d ~1 mg kg-1 d-1.

8 12 4~8 . SLE 15 56 . 54 . 58 .. 1 .. CRDC . SLE 55 59 . 4 >30% . SLE . 4 SLE 1A 60 .. 1B . SLE > mg/d SLE . 10 mg/d . ~1 mg kg d SLE -1 -1. mg/d SLE . 61 62 . 2C SLE 1 mg kg d -1 1. 2 63 . 5 SLE. 2C 5 SLE . SLE 1B 1A . SLE 1 . 5 1 . 1C 2C . SLE SLE SLE . SLE . 12 13 15 53 56 57 64 67 5 . 176 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3. 2 2C . mg . 20 73 . 25 SLE . 5 74 75 . 5 . 4 . 4. 76 77 . SLE .. 3 78-97 . / . 7 SLE .. 7 / . 68 70 . SLE . 5 . 2B . 71 72 . SLE . 1 . 98 101 . 6 SLE SLE .. 6 SLE FDA CFDA . SLE SLE . 2B . 3 .. SLE 75 .. 78 79 . 6 . 80 .. SLE SLE .. 73, 76, 81 76, 81 . 1~3. 73, 82 83 . 84 85 . 85.

9 86 87 . SLE SLE . 73 73, 88 .. 1~3 87 89 .. SLE 78 .. 78, 90 92 90 91 . 94 . 93 . SLE . 95 97 . 96 . 95 96 . SLE 80 SLE 80 . 80 . SLE . 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3 177 . 4 . FDA CFDA.. , 98 . 98, 101 .. FDA . CFDA . 4 . 8 SLE . 107 . Meta . 2C / . 2C . + + 77 .. 1B 1B 1B ACEI / ARB . 1B 108 .. 1B . 2B 2B P . ACEI / ARB . 2C MRI 109 . MRI T1 T2 .. 2C MRI 110 .. 2B . 2B .. 2D SLE . 2D 2D 96% . SLE . 80% .. 2C SLE . 111 113 SLE .. 102 104 100 mg . 4 . 80% . 105 106 / . 114 116 . 9 SLE. Meta / / + / + 9 SLE . 2C . OR= 95%CI SLE . ~ 2D . OR= 95%CI ~ 2018 . / / + / + 22 SLE . OR= DNA SLE.. 95%CI ~ OR= 95%CI 117.

10 ~ OR= 95%CI ~ SLE . 76 .. 118 119 . 178 2020 3 59 3 Chin J Intern Med March 2020, Vol. 59, No. 3. SLE .. 120 121 .. SLE . 95%CI ~ 136 137 SLE .. 122 123 .. 10 . SLE . 138 .. 10 SLE SLE . SLE . 1B . SLE . SLE 137 141 . 50% 124 OR= 95%CI ~ SLE . OR= 95%CI ~ . SLEDAI OR= 95%CI ~ SLE . OR= 95%CI ~ . OR= 95%CI ~ SLE . C 50 mg/L. 93 125 142 144 SLE . g/L 109/ . L HR= 95%CI ~ 145 A . 126 128 SLE . 87 . 11 . SLE 12 SLE . 11 SLE 6 . 12 SLE SLE . 2B . 1 . 2 . 1B . 3 . 4 . 5 . 6 . SLE SLE D 1C . 1C 1B SLE .. 2C SLE . 146 147 . SLE 148 149 SLE . SLE . / 150 152 . SMD=- 95%CI - ~ - MD=. SLE 129 130 . 95%CI ~ . 153 154 .. SMD= 95%CI ~ SMD=.