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成人系统性红斑狼疮治疗及预后概述

Authors
Peter H Schur, MD
Daniel J Wallace, MD
Section Editor
David S Pisetsky, MD, PhD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
梅长林, 主任医师，教授

引言

系统性红斑狼疮(systemic lupus erythematosus, SLE)是一种慢性、有时会危及生命的多系统疾病。患者会出现一系列临床症状并且预后多变，其预后取决于器官受累的类型和严重程度。实施治疗前应确定SLE的诊断(表 1)。 (参见“成人系统性红斑狼疮的诊断与鉴别诊断”)

由于病程的不确定性，所以有效的治疗需要医患双方进行不间断的沟通，以正确地解释实验室检查结果、缓解症状、预防和治疗复发、减少药物治疗相关的副作用、改善患者对药物的依从性以及与患者的初级保健医生协同进行治疗[1-6]。

本专题将总结SLE患者治疗和预后相关的一般问题。特定器官受累的治疗将单独讨论。(参见相关专题。)

疾病活动性和严重度的判断

一个有效的治疗方案首先需明确诊断，并准确判定疾病的活动性和严重度[7-11]。疾病活动性通常指的是炎症程度，而严重度则取决于器官功能障碍的程度和器官的相对重要性。不可逆的器官功能障碍程度被称为“损伤指数”[12]。

存在重度器官功能障碍并不一定意味着存在持续性炎症。例如，显著的蛋白尿和肾小球滤过率逐渐降低可能是活动性炎症所致，也可能是在不存在活动性炎症疾病的情况下由瘢痕性肾单位所致。鉴别这两种可能性的能力极其重要，因为后种情况没有应用免疫抑制治疗的指征。 (参见“弥漫性或局灶性增生性狼疮性肾炎的治疗”)

                                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-13.
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