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儿童 DLE 的基于实践的差异

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Article first published online: 01 Oct 2019
DOI: 10.1111/bjd.18407

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Summary

术语“红斑狼疮”指的是一系列相关疾病。盘状红斑狼疮 (DLE) 是一种在儿童中罕见的皮肤红斑狼疮。其可导致毁容性瘢痕。某些患者出现系统性红斑狼疮 (SLE),这是一种影响全身的红斑狼疮,其可导致多器官损害。多项小型研究表明,25 ‐ 30% 的 DLE 儿童患者随时间推移出现 SLE,但与此相关的风险因素尚不明确。SLE 早期诊断和治疗很有帮助。本研究采用一种调查方法来比较美国和加拿大两个医学专业(学术型风湿科医师和皮肤科医师)为 DLE 儿童患者提供护理的实践模式。本研究的目的在于识别两组间的一致方面,以及基于实践的差异。若两个专业达到 70% 或更多的一致,则出现共识(一致)。作者发现了应在所有儿童诊断为 DLE 时查看某些实验室研究的共识。两组都同意,存在“除 ANA 以外的其他自身抗体”、关节炎或肾炎是 SLE 的高风险特性,对此应增加系统性疾病的筛查。没有其他一致同意的 SLE 风险因素,包括先前在 DLE 成人患者中显示的风险因素。两组都同意,泛发性 DLE 的一线系统性疗法(全身治疗)应为羟氯喹。作者未就哪些药物可用于治疗耐药性皮肤病达成一致。总而言之,本研究发现某些一致方面,但许多方面存在基于实践的差异。需要有关 DLE 儿童患者的更多数据来确定最佳实践方法。作者正在开展一项回顾性队列研究,该研究可能有助于填补这一空白。

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