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] Hongyu Tao, Jingjing Ye, Jin Yu, Xiuzhen Yang, Jingjing Qian, Bin Xu, Weize Xu, Qiang Shu. Value of contrast transthoracic echocardiography in assessing right-to-left shunt-related diseases in children[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 959-965.
[2] Hongbin Wang, Hongxia Zhang, Wen He, Lijuan Du, Linggang Cheng, Yukang Zhang, Meng Zhang. Ultrasound and contrast-enhanced ultrasound features of low-grade appendiceal mucinous tumor and appendiceal mucinous adenocarcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(09): 865-871.
[3] Lili Gu, Fan Jiang. Survey and analysis of quality of screening prenatal ultrasound images in Anhui Province[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 671-674.
[4] Ying Xiong, Jinglai Lin, Qi Bai, Jianming Guo, Shuo Wang. How far is AI from clinical application in automated renal cell carcinoma pathological diagnosis?[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 535-540.
[5] Yuanyuan Yuan, Leqi Yue, Huaxing Zhang, Yan Wu, Quanhai Li. Advances in the distribution in lung tissue and therapeutic mechanisms of mesenchymal stem cells in respiratory system diseases models[J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2024, 14(06): 374-381.
[6] Qiusheng Wang. Diagnosis and treatment strategy for benign biliary diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 779-782.
[7] Yu Gong, Yuan Liao, Mei Shang. Influencing factors and prediction model for recurrence of hepatocellular carcinoma after TACE[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 818-824.
[8] Yifan Li, Diwen Zhu, Weixin Ren, Yingjun Bao, Junpeng Gu, Haixiao Zhang, Gengfei Cao, Weizheng Ji. Role of serum GP73 level in the evaluation of TACE efficacy for primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 825-830.
[9] Xuefeng Zhou, Zheyi Dong, Zhe Feng, Guangyan Cai, Xiangmei Chen. Formulation protocol of guidelines for diagnosis and treatment of diabetic kidney disease with integrated traditional Chinese and Western medicine[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(06): 301-305.
[10] Chen Zhang, Ming Qin, Juan Dong, Yulong Chen. Diagnostic value of ultrasound in ischemic changes of intestinal volvulus in children[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 565-568.
[11] Hao Li, Qishuai Chen, Fazhu Fei, Ningwei Zhang, Yuandong Li, Shuochen Wang, Bin Ren. Progress in noninvasive diagnosis of liver fibrosis in chronic liver disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 863-867.
[12] Ruiyi Tan. Current advances and developments in diagnosis and treatment of small cell osteosarcoma[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(08): 781-784.
[13] Fangming Liu, Xiuxiu Shi, Chong Tang, Keshi Zhang, Ying Xu, Guishan Wang, Zhenpeng Guan, Xiao Li. Awareness and demand for application of digital therapeutics among orthopedic rehabilitation patients: an analysis of results based on 928 questionnaires[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 654-661.
[14] Ziyang Wang, Hongbin Wang, Xiaojing Liu. Progress in research of serum markers for diagnosis of alpha-fetoprotein negative hepatocellular carcinoma[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 677-681.
[15] Hui Chen, Zupeng Zou, Tiantian Zhou, Yidan Zhang, Haiping Zhang. Progress in research of dermoscopy in differential diagnosis of erythematous dermatosis on the scalp[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 692-698.
Viewed
Full text


Abstract