Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2017, Vol. 13 ›› Issue (04): 378 -383. doi: 10.3877/cma.j.issn.1673-5250.2017.04.002

Special Issue:

Editorial

Research update on diagnosis and treatment of pediatric systemic lupus erythmatosus

Jun Gu1, Chaobin Shen2,()   

  1. 1. Department of Pediatrics, Shanghai General Hospital, Shanghai 200080, China
    2. Department of Pediatrics, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China
  • Received:2017-03-20 Revised:2017-06-30 Published:2017-08-01
  • Corresponding author: Chaobin Shen
  • About author:
    Corresponding author: Shen Chaobin, Email:

Systemic lupus erythematosus (SLE) is a kind of disease with chronic multisystem autoimmune disorders. Childhood-onset SLE is associated with higher morbidity and mortality than those of adult-onset SLE. Early onset of SLE is associated with an increased number of known SLE-susceptibility risk alleles. The Systemic Lupus International Collaborating Clinics (SLICC) developed SLE clinical diagnosis criteria in 2012, which exhibited a higher sensitivity and lower specificity than other criteria before. The aim of child SLE treatment with early immunosuppression is to inhibit autoimmune response and non-specific inflammation in a short time and decrease SLE activity. This article tries to elaborates current diagnosis and treatment of SLE in children.

表1 SLICC制定的SLE临床诊断标准
临床分类指标 免疫学指标
急性皮肤红斑:面部蝶形红斑、大泡性狼疮、中毒性表皮坏死松解症、斑丘疹和光敏性皮炎,并排除皮肌炎和亚急性皮肤狼疮 抗核抗体呈阳性
慢性皮肤狼疮:典型盘状狼疮、局部或广泛的增厚性狼疮、狼疮性脂膜炎、黏膜狼疮、全身性狼疮、冻疮样狼疮和苔藓样重叠样狼疮 抗双链DNA抗体呈阳性,ELISA法检测抗双链DNA抗体滴度结果显示≥2倍滴度
口腔溃疡:无其他病因可解释的上腭、颊部、舌体或鼻黏膜溃疡 抗sm抗体呈阳性
非瘢痕性脱发:无其他病因可解释的毛发弥漫性稀薄或发质脆性增加,抗磷脂抗体呈阳性:包括抗狼疮凝集物,RPR结果呈假阳性,抗心磷脂抗体中等或高度滴度增高(IgA、IgG或IgM),抗β2-糖蛋白滴度增高(IgA、IgG或IgM) ?
≥2个关节发生滑膜炎,表现为关节肿胀和关节液渗出,关节晨僵症状持续30 min以上 补体水平降低:补体3、4水平降低,总补体活性降低
典型的胸、肋膜浆膜炎,或胸腔积液、胸膜摩擦音、心包炎样疼痛≥1 d,或心电图检查结果呈心包炎样 无溶血性贫血时,直接Coombs试验结果呈阳性
肾脏:尿蛋白/肌酐水平增高,或24 h尿蛋白水平>500 mg,可有红细胞管型出现 ?
神经系统:无其他病因可解释的惊厥、神经精神症状、多发性单神经炎、脊髓炎、外周或颅内神经病变和急性意识丧失等 ?
溶血性贫血 ?
白细胞计数降低:无其他病因可解释的白细胞计数<4×109/L(>1次) ?
血小板计数降低:无其他病因可解释的血小板计数<100×109/L(>1次) ?
[1]
Barsalou J, Levy DM, Silverman ED. An update on childhood-onset systemic lupus erythematosus[J]. Curr Opin Rheumatol, 2013, 25(5): 616-622.
[2]
Aggarwal A, Srivastava P. Childhood onset systemic lupus erythematosus: how is it different from adult SLE?[J]. Int J Rheum Dis, 2015, 18(2): 182-191.
[3]
Hollander MC, Sage JM, Greenler AJ, et al. International consensus for provisions of quality-driven care in childhood-onset systemic lupus erythematosus[J]. Arthritis Care Res (Hoboken), 2013, 65(9): 1416-1423.
[4]
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus[J]. Arthritis Rheum, 2012, 64(8): 2677-2686.
[5]
Thakral A, Klein-Gitelman MS. An update on treatment and management of pediatric systemic lupus erythematosus[J]. Rheumatol Ther, 2016, 3(2): 209-219.
[6]
Moulton VR, Suarez-Fueyo A, Meidan E, et al. Pathogenesis of human systemic lupus erythematosus: a cellular perspective[J].Trends Mol Med, 2017, 23(7): 615-635. .
[7]
Webb R, Kelly JA, Somers EC, et al. Early disease onset is predicted by a higher genetic risk for lupus and is associated with a more severe phenotype in lupus patients[J]. Ann Rheum Dis, 2011, 70(1): 151-156.
[8]
Kirou KA, Gkrouzman E. Anti-interferon alpha treatment in SLE[J]. Clin Immunol, 2013, 148(3): 303-312.
[9]
Sun XG, Tao JH, Xiang N, et al. Negative correlation between miR-326 and Ets-1 in regulatory T cells from new-onset SLE patients[J]. Inflammation, 2016, 39(2): 822-829.
[10]
Lu MC, Lai NS, Chen HC, et al. Decreased microRNA (miR)-145 and increased miR-224 expression in T cells from patients with systemic lupus erythematosus involved in lupus immunopathogenesis[J]. Clin Exp Immunol, 2013, 171(1): 91-99.
[11]
Husakova M. MicroRNAs in the key events of systemic lupus erythematosus pathogenesis[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2016, 160(3): 327-342.
[12]
Jacob CO, Reiff A, Armstrong DL, et al. Identification of novel susceptibility genes in childhood-onset systemic lupus erythematosus using a uniquely designed candidate gene pathway platform[J]. Arthritis Rheum, 2007, 56(12): 4164-4173.
[13]
Armstrong DL, Reiff A, Myones BL, et al. Identification of new SLE-associated genes with a two-step Bayesian study design[J]. Genes Immun, 2009, 10(5): 446-456.
[14]
Dudhgaonkar S, Ranade S, Nagar J, et al. Selective IRAK4 inhibition attenuates disease in murine lupus models and demonstrates steroid sparing activity[J]. J Immunol, 2017, 198(3): 1308-1319.
[15]
Kasturi S, Sammaritano LR. Corticosteroids in lupus[J]. Rheum Dis Clin North Am, 2016, 42(1): 47-62.
[16]
Lam NC, Ghetu MV, Bieniek ML. Systemic lupus erythematosus: primary care approach to diagnosis and management[J]. Am Fam Physician, 2016, 94(4): 284-294.
[17]
Ruiz-Arruza I, Ugarte A, Cabezas-Rodriguez I, et al. Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus[J]. Rheumatology, 2014, 53(8): 1470-1476.
[18]
Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis[J]. Ann Rheum Dis, 2012, 71(11): 1771-1782.
[19]
Sun L, Liu M, Li R, et al. Hydroxychloroquine, a promising choice for coronary artery disease?[J]. Med Hypotheses, 2016, 93: 5-7.
[20]
Shulman S, Wollman J, Brikman S, et al. Implementation of recommendations for the screening of hydroxychloroquine retinopathy: poor adherence of rheumatologists and ophthalmologists[J]. Lupus, 2017, 26(3): 277-281.
[21]
Marmor MF, Hu J. Effect of disease stage on progression of hydroxychloroquine retinopathy[J]. JAMA Ophthalmol, 2014, 132(9): 1105-1112.
[22]
Mina R, von Scheven E, Ardoin SP, et al. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus[J]. Arthritis Care Res (Hoboken), 2012, 64(3): 375-383.
[23]
Tornatore KM, Meaney CJ, Wilding GE, et al. Influence of sex and race on mycophenolic acid pharmacokinetics in stable African American and Caucasian renal transplant recipients[J]. Clin Pharmacokinet, 2015, 54(4): 423-434.
[24]
Sinha R, Raut S. Pediatric lupus nephritis: management update[J]. World J Nephrol, 2014, 3(2): 16-23.
[25]
Houssiau FA, Vasconcelos C, D′Cruz D, et al. The 10-year follow-up data of the euro-lupus nephritis trial comparing low-dose and high-dose intravenous cyclophosphamide[J]. Ann Rheum Dis, 2010, 69(1): 61-64.
[26]
Oktem O, Guzel Y, Aksoy S, et al. Ovarian function and reproductive outcomes of female patients with systemic lupus erythematosus and the strategies to preserve their fertility[J]. Obstet Gynecol Surv, 2015, 70(3): 196-210.
[27]
Thompson AJ, Newman WG, Elliott RA, et al. The cost- effectiveness of a pharmacogenetic test: a trial-based evaluation of TPMT genotyping for azathioprine[J]. Value Health, 2014, 17(1): 22-33.
[28]
Liu F, Ma R, Riordan SM, et al. Azathioprine, mercaptopurine, and 5-aminosalicylic acid affect the growth of IBD-associated campylobacter species and other enteric microbes[J]. Front Microbiol, 2017, 8: 527.
[29]
Alexander T, Arnold R, Hiepe F. Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus[J]. Z Rheumatol, 2016, 75(8): 770-779.
[30]
Reddy V, Martinez L, Isenberg DA, et al. Pragmatic treatment of patients with systemic lupus erythematosus with rituximab: long-term effects on serum immunoglobulins[J]. Arthritis Care Res (Hoboken), 2017, 69(6): 857-866.
[31]
Jordan NP, D′Cruz DP. Efficacy, pharmacokinetic and pharmacodynamic profile of belimumab for systemic lupus erythematosus[J]. Expert Opin Drug Metab Toxicol, 2015, 11(10): 1635-1645.
[32]
Guerreiro Castro S, Isenberg DA. Belimumab in systemic lupus erythematosus (SLE): evidence-to-date and clinical usefulness[J]. Ther Adv Musculoskelet Dis, 2017, 9(3): 75-85.
[33]
Hui-Yuen JS, Nguyen SC, Askanase AD. Targeted B cell therapies in the treatment of adult and pediatric systemic lupus erythematosus[J]. Lupus, 2016, 25(10): 1086-1096.
[34]
Perl A. mTOR activation is a biomarker and a central pathway to autoimmune disorders, cancer, obesity, and aging[J]. Ann N Y Acad Sci, 2015, 1346(1): 33-44.
[35]
Sthoeger Z, Sharabi A, Mozes E. Novel approaches to the development of targeted therapeutic agents for systemic lupus erythematosus[J]. J Autoimmun, 2014, 54: 60-71.
[1] Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[2] Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[3] Baofu Zhang, Jin Yu, Jingjing Ye, Jiangen Yu, Xiaohui Ma, Xiwang Liu. Echocardioimagedata diagnosis of anomalous pulmonary venous connection caused by congenital malposition of the septum primum[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1074-1080.
[4] Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[5] Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.
[6] Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[7] Heng Lyu, Licong Dong, Haiqin Xie, Zhuofei Zhao, Li Liu, Desheng Sun. CT-ultrasound comparison for evaluating missed diagnosis of focal liver lesions by ultrasound: a single-center cross-sectional quality control survey[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 712-716.
[8] Jiu Wang, Jun Chen, Xia Zhu, Yangjin Mima, Sheng Zhao, Xinlin Chen, Jianhua Li, Shuang Wang. Effect of implementing fetal systemic ultrasound screening in Material and Child Health Hospital of Shannan[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 728-733.
[9] Jie Mi, Chen Chen, Jialing Li, Haina Pei, Hengbo Zhang, Fei Li, Dongjie Li. Analysis of the characteristics of children's head and face trauma[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(06): 511-515.
[10] Yi He, Dongsheng Yu. Advances in diagnosis and treatment of dislocation injury of young permanent teeth[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2023, 17(06): 400-406.
[11] Xu Peng, Yongfu Shao, Duo Li, Rui Zhou, Zhenming Xing. Diagnosis and surgical treatment of hepatocolon flexure[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 108-110.
[12] Xinxin Sun, Jun Liu, Chaowu Chen, Chao Sun. Application of endoscopic ultrasonography-guided fine needle aspiration in pancreatic space-occupying lesions[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 418-421.
[13] Xiangyu Zhu, Jianmei Wang, Hui Zhang, Hongying Ye. Correlation analysis between left ventricular function parameters and liver cirrhosis using non-invasive left ventricular pressure-strain cycle[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 494-498.
[14] Tian Li, Hong Xu, Heliang Liu. Progress in research of pneumoconiosis[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 900-905.
[15] Jing Li, Lingling Zhang, Wei Xing. Value of concept of interest induction before anesthesia induction in pediatric surgery and its effect on family satisfaction[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 812-817.
Viewed
Full text


Abstract