中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (9): 746-751.DOI: 10.19538/j.ek2025090608

• 专题笔谈 • 上一篇    下一篇

儿童系统性红斑狼疮的诊断与治疗

  

  1. 中南大学湘雅二医院儿童医学中心肾脏风湿免疫专科，湖南  长沙  410011
  • 出版日期:2025-09-06 发布日期:2025-10-20
  • 通讯作者: 吴小川，电子信箱：xiaochuanwu@csu.edu.cn
  • 基金资助:
    国家自然科学基金专项项目（32441100）；湖南省自然科学基金项目（2025JJ60709）

Diagnosis and treatment of childhood-onset systemic lupus erythematosus

  1. Department of Nephrology and Rheumatology，Children's Medical Center，The Second Xiangya Hospital of Central South University，Changsha  410011，China
  • Online:2025-09-06 Published:2025-10-20

摘要： 儿童系统性红斑狼疮（childhood-onset systemic lupus erythematosus，cSLE）是一种慢性自身免疫性疾病，与成人相比，具有起病较急、病情较重、预后较差的特点。早期诊断和规范化治疗对改善预后至关重要。目前诊断主要采用基于成人群体建立的2012年系统性狼疮国际合作组（SLICC）和2019年欧洲抗风湿病联盟/美国风湿病学会（EULAR/ACR）标准，虽然这些标准在cSLE诊断中表现良好，但在实际应用中仍存在局限性。治疗强调以“treat-totarget”为目标，实施个体化治疗。常规治疗以激素联合免疫抑制剂为主，生物制剂的应用有助于减少激素用量、降低疾病活动度、减少疾病复发等。2024年ACR指南推荐的多靶点联合治疗方案在增殖性狼疮性肾炎患者中展现出良好前景，但在儿童患者中的确切疗效和长期安全性仍需进一步验证。

关键词: 系统性红斑狼疮, 靶向治疗, 个体化治疗

Abstract: Childhood-onset systemic lupus erythematosus（cSLE） is a chronic autoimmune disease characterized by acuter onset，severer clinical manifestations，and poorer prognosis than those of adult-onset SLE. Early diagnosis and standardized treatment are crucial for improving outcomes. Currently，the diagnosis primarily relies on the 2012 SLICC and 2019 EULAR/ACR criteria，which were developed based on adult populations. Although these criteria perform well in the diagnosis of cSLE，they still have limitations in clinical practice. In the treatment a "treat-to-target" goal is emphasized and individualized treatment is conducted. Conventional therapy primarily consists of glucocorticoids combined with immunosuppressants，while the use of biologics can help reduce steroid use，lower disease activity，and decrease disease recurrences. The 2024 ACR guidelines recommend multitarget combination therapy for proliferative lupus nephritis，which shows promising results in adult patients. However，its actual efficacy and long-term safety in pediatric populations still require further validation.

Key words: systemic lupus erythematosus, targeted therapy, individualized treatment