Objectives: To explore the changes and significance of resolvin D1 (RvD1) in the treatment of systemic lupus erythematosus (SLE) with Belimumab. Methods: The clinical data from patients with moderate to severe disease activity SLE who received oral stable doses of glucocorticoids (≤10 mg/d) and/or immunosuppressants for more than 3 months at the outpatient or inpatient department of the First Affiliated Hospital of Soochow University from January 2022 to November, 2023 were retrospectively collected. All patients were treated with 10 mg/kg intravenous infusion of Belimumab. The medication was administered once on the 1st, 15th, and 29th days, and then every 4 weeks for a total of 24 weeks and 8 doses. Peripheral blood plasma before and after treatment were collected, and RvD1 levels before and after treatment were detected using enzyme-linked immunosorbent assay (ELISA). According to the guidelines, SLE patients were divided into kidney involvement group and kidney non-involvement group; the patients were further divided into a blood system involvement group and a blood system non-involvement group; according to the SLE Disease Activity Index (SLEDAI), the patients were divided into moderate activity group and severe activity group. After 24 weeks of treatment, the patients were divided into complete remission group, low disease activity group, and no remission group according the treatment effects. The changes in plasma RvD1 levels in each group before and after treatment with Belimumab were analyzed, and their correlation with various activity indicators of SLE was checked too. Results: A total of 81 patients were included, of which 15 were male and 66 were female, with an average age of (33.14±8.27) years. At baseline, plasma RvD1 levels in SLE patients were negatively correlated with SLEDAI scores (r=-0.642, P<0.001) and anti dsDNA antibody levels (r=-0.623, P=0.012). There was no significant difference in plasma RvD1 level [M(Q1, Q3)] between SLE patients with renal involvement (n=50) and those without renal involvement (n=31) [73.27 (45.16, 122.12) ng/L vs 58.32 (32.29, 94.33) ng/L, P=0.365]. There was no significant difference in plasma RvD1 level between SLE patients with hematological involvement (n=40) and those without hematological involvement (n=41) [74.78 (47.01, 121.67) ng/L vs 42.88 (30.05, 76.76) ng/L, P=0.277]. The plasma RvD1 level in the moderate activity group (n=51) was significantly higher than that in the severe activity group (n=30) [104.76 (65.65, 135.34) ng/L vs 55.86 (37.53, 81.35) ng/L, P=0.002]. After 24 weeks of treatment with Belimumab, plasma RvD1 levels in the complete remission group (n=10) were both significantly higher than those in the low disease activity group (n=61) and the non-remission group (n=10) [196.48 (123.08, 236.33) ng/L vs 98.87 (63.35, 110.23) ng/L and 77.68 (41.73, 128.55) ng/L, respectively, P=0.001]. After the treatment, the plasma RvD1 levels in both the complete remission group and the low disease activity group increased significantly when compared to those before the treatment [98.23 (40.45, 107.19) ng/L vs 176.48 (123.08, 226.33) ng/L and 65.27 (31.76, 94.35) ng/L vs 98.87 (63.35, 110.23) ng/L, both P<0.05]. Further analysis revealed that all the patients of complete remission group after treatment were from the moderate disease activity group before treatment, and the plasma RvD1 level in the complete remission group was significantly higher than that in the low disease activity group before the treatment [98.23 (40.45, 127.19) vs 65.27 (31.76, 94.35) ng/L] (P=0.022). Conclusions: The plasma RvD1 level significantly increased after treatment with Belimumab in SLE patients, patients with higher plasma RvD1 level before treatment have better efficacy with Belimumab.
目的： 探讨消退素D1（RvD1）在贝利尤单抗治疗系统性红斑狼疮（SLE）患者中的变化。 方法： 回顾性收集2022年1月到2023年11月苏州大学附属第一医院门诊或住院的、口服稳定剂量糖皮质激素（≤10 mg/d）和（或）免疫抑制剂3个月以上的中重度疾病活动度SLE患者临床资料。所有患者予贝利尤单抗10 mg/kg静脉输注治疗方案。其中，第1、15、29天分别给药1次，此后每4周给药1次，直至24周，共计8次。收集治疗前后外周血血浆，检测治疗前后血浆RvD1水平。治疗前依据现有指南将SLE患者分为肾脏累及组和肾脏非累及组；又将SLE患者分为血液系统累及组和血液系统未累及组；依据SLE疾病活动度指数（SLEDAI）将SLE患者分为中度活动组和重度活动组；治疗24周后，将患者分为完全缓解组、低疾病活动度组和无缓解组。分析贝利尤单抗治疗前后各组血浆RvD1水平变化，及其与SLE各项活动性指标及疗效的相关性。 结果： 共纳入患者81例，其中男15例，女66例，年龄（33.14±8.27）岁。基线时，SLE患者血浆RvD1水平与SLEDAI评分（r=-0.642，P<0.001）和抗双链DNA（dsDNA）抗体水平呈负相关（r=-0.623，P=0.012）。无肾脏累及组（n=31）和肾脏累及组（n=50）血浆RvD1水平相当［M（Q1，Q3）］［73.27（45.16，122.12）比58.32（32.29，94.33）ng/L，P=0.365］，血液系统累及组（n=40）与无血液系统累及组（n=41）水平亦相当［74.78（47.01，121.67）比42.88（30.05，76.76）ng/L，P=0.277］；中度活动组（n=51）血浆RvD1水平高于重度活动组（n=30）［104.76（65.65，135.34）比55.86（37.53，81.35）ng/L，P=0.002］。贝利尤单抗治疗24周后，低疾病活动度组（n=61）和无缓解组（n=10）血浆RvD1水平均低于完全缓解组（n=10）［M（Q1，Q3）］［196.48（123.08，236.33）比98.87（63.35，110.23）和77.68（41.73，128.55）ng/L，P=0.001］；完全缓解组与低疾病活动度组治疗后血浆RvD1水平均较治疗前升高［98.23（40.45，107.19）ng/L比176.48（123.08，226.33）ng/L和65.27（31.76，94.35）ng/L 比98.87（63.35，110.23）ng/L，均P<0.05］。治疗后完全缓解组患者在治疗前均为疾病中度活动组患者，治疗前血浆RvD1水平高于低疾病活动组［98.23（40.45，127.19）比65.27（31.76，94.35）ng/L］（P=0.022）。 结论： SLE患者血浆RvD1水平在贝利尤单抗治疗后明显升高，治疗前血浆RvD1水平较高的患者贝利尤单抗疗效较好。.