Sex differences in systemic lupus erythematosus(SLE):an inception cohort of the Chinese SLE Treatment and Research Group(CSTAR)registry XVII

作     者：Yinli Gui Wei Bai Jian Xu Xinwang Duan Feng Zhan Chen Zhao Zhenyu Jiang Zhijun Li Lijun Wu Shengyun Liu Min Yang Wei Wei Ziqian Wang Jiuliang Zhao Qian Wang Xiaomei Leng Xinping Tian Mengtao Li Yan Zhao Xiaofeng Zeng CSTAR co-authors Yinli Gui;Wei Bai;Jian Xu;Xinwang Duan;Feng Zhan;Chen Zhao;Zhenyu Jiang;Zhijun Li;Lijun Wu;Shengyun Liu;Min Yang;Wei Wei;Ziqian Wang;Jiuliang Zhao;Qian Wang;Xiaomei Leng;Xinping Tian;Mengtao Li;Yan Zhao;Xiaofeng Zeng;CSTAR co-authors

作者机构：Department of Rheumatology and Clinical ImmunologyChinese Academy of Medical Sciences&Peking Union Medical CollegeNational Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID)Ministry of Science&TechnologyState Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College Hospital(PUMCH)Key Laboratory of Rheumatology and Clinical ImmunologyMinistry of EducationBeijing 100730China Department of RheumatologyThe People’s Hospital of ZhengzhouZhengzhouHenan 450003China Department of RheumatologyFirst Affiliated Hospital of Kunming Medical UniversityKunmingYunnan 650032China Department of RheumatologyThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi 330006China Department of RheumatologyHainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikouHainan 570311China Department of RheumatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxi 530021China Department of RheumatologyThe Bethune First Hospital of Jilin UniversityChangchunJilin 130021China Department of RheumatologyThe Affiliated Hospital of Bengbu Medical CollegeBengbuAnhui 233004China Department of RheumatologyThe People’s Hospital of Xinjiang Autonomous RegionUrumqiXinjiang 830001China Department of RheumatologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450052China Department of Rheumatology and ImmunologyNanfang HospitalSouthern Medical UniversityGuangzhouGuangdong 510515China Department of RheumatologyTianjin Medical University General HospitalTianjin 300052China 不详 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2022年第135卷第18期

页      面：2191-2199页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by grants from the Chinese National Key Technology R&D Program,Ministry of Science and Technology(Nos.2021YFC2501301-5 and 2017YFC0907601-3) Beijing Municipal Science&Technology Commission(No.Z201100005520022,23,and 25–27) CAMS Innovation Fund for Medical Sciences(CIFMS,2021-I2M-1-005). 

主　　题：Systemic lupus erythematosus Lupus nephritis Sex End-stage renal disease Sex differences 

摘      要：Background:The onset and clinical presentation of systemic lupus erythematosus(SLE)are sex-related.Few studies have investigated the distinctions in clinical characteristics and treatment preferences in male and female SLE patients in the initial cohort.This study aimed to improve the understanding of Chinese SLE patients by characterizing the different sexes of SLE patients in the inception cohort.Methods:Based on the initial patient cohort established by the Chinese SLE Treatment and Research Group,a total of 8713 patients(795 men and 7918 women)with newly diagnosed SLE were enrolled between April 2009 and March 2021.Of these,2900 patients(347 men and 2553 women)were eligible for lupus nephritis(LN).A cross-sectional analysis of the baseline demographic characteristics,clinical manifestations,laboratory parameters,organ damage,initial treatment regimens,and renal pathology classification was performed according to sex.Results:In the SLE group,as compared to female patients,male patients had a later age of onset(male vs.female:37.0±15.8 years vs.35.1±13.7 years,P=0.006)and a higher SLE International Collaborative Clinic/American College of Rheumatology damage index score(male vs.female:0.47±1.13 vs.0.34±0.81,P=0.015),LN(male vs.female:43.6%vs.32.2%,P0.001),fever(male vs.female:18.0%vs.14.6%,P=0.010),thrombocytopenia(male vs.female:21.4%vs.18.5%,P=0.050),serositis(male vs.female:14.7%vs.11.7%,P=0.013),renal damage(male vs.female:11.1%vs.7.4%,P0.001),and treatment with cyclophosphamide(CYC)(P0.001).The frequency of leukopenia(male vs.female:20.5%vs.25.4%,P=0.002)and arthritis(male vs.female:22.0%vs.29.9%,P0.001)was less in male patients with SLE.In LN,no differences were observed in disease duration,SLE Disease Activity Index score,renal biopsy pathological typing,or 24-h urine protein quantification among the sexes.In comparisons with female patients with LN,male patients had later onset ages(P=0.026),high serum creatinine(P0.001),higher end-stage renal failure rates(P=0.002),musculoskeletal damage(P=0.023),cardiovascular impairment(P=0.009),and CYC use(P=0.001);while leukopenia(P=0.017),arthritis(P=0.014),and mycophenolate usage(P=0.013)rates were lower.Conclusions:Male SLE patients had more severe organ damage and a higher LN incidence compared with female SLE patients;therefore,they may require more aggressive initial treatment compared to female patients.