| Objective:Discuss the correlation between the blood concentration of hydroxychloroquine and dose,disease activity,clinical indicators,ocular adverse reactions in patients with SLE after taking hydroxychloroquine,and to evaluate the optimal,safe,and effective blood concentration of hydroxychloroquine.Methods:From July 2022 to December 2022,135 patients with SLE were retrospectively collected from the Rheumatology Department of the First Affiliated Hospital of Nanchang University,who had been receiving hydroxychloroquine for more than six months.Their basic information,clinical indicators,SLE disease activity score,concomitant medication,and ocular adverse reactions were recorded.The blood concentration of hydroxychloroquine was determined by high performance liquid chromatography mass spectrometry.The parameters of the macular region of the retina were measured using OCTA.Compare the relationship between different doses of hydroxychloroquine and blood concentration,evaluate the correlation between the blood concentration of hydroxychloroquine and clinical indicators,compare the differences in blood concentration of hydroxychloroquine at different disease activity levels,determine the effective blood concentration of hydroxychloroquine based on the ROC curve,compare the differences in clinical indicators at different blood concentrations,and compare the correlation between OCTA results and hydroxychloroquine.Results:(1)Among the 135 patients,there were 129 females and 6 males,aged 40±12years old.The SLEDAI score distribution rang 0-9 points,with 121 cases of disease remission and 14 cases of disease activity.The blood concentration of hydroxychloroquine in the whole blood is 453.60ng/ml.(2)The blood concentration of hydroxychloroquine increases with the increase of dosage,with the 400mg/d group having the highest blood concentration,and the difference is statistically significant compared to the 200mg/d group and the 100mg/d group(P<0.05).(3)The blood concentration of hydroxychloroquine is positively correlated with daily dose,body mass dependent dose,WBC,Hb,PLT,HDL(P<0.05),and negatively correlated with SLEDAI score,CRP,ESR,and Ig G(P<0.05).(4)After grouping according to the SLEDAI score,the blood concentration of hydroxychloroquine in disease relief group(SLEDAI≤4)was larger than that in the active group(SLEDAI>4)(455.18 VS 391.01ng/ml),and there is a significant difference between the two groups(Z=-1.977,P<0.05).(5)Logistic regression analysis of the influencing factors of lupus disease activity shows that the blood concentration of hydroxychloroquine is an influencing factor of disease activity(OR=0.997,95%CI=0.993-1.000,P=0.042).(6)The critical value of effective blood concentration of hydroxychloroquine obtained from ROC curve analysis is 491.51ng/ml,with a senstivity of 47.9%and a specificity of 92.9%(AUC=0.662,P=0.048,95%CI=0.529-0.794).(7)Based on the critical value of effective blood concentration of hydroxychloroquine,patients were divided into low concentration and high concentration groups.The comparison of clinical indicators between the two groups was as follows:the low concentration group had higher SLEDAI score and ESR.SLEDAI:4(2,4)VS 2(2,4),Z=-5.429,P=0.000;ESR:12(7,18)VS 9(5,15),Z=-2.127,P=0.033.The low concentration group has lower daily dose,body mass dependent dose,Hb,PLT,HDL.HCQ daily dose:200(200,400)VS 400(300,400),Z=-4.828,P=0.000;body mass dependent dose:3.96(3.33,6.26)VS 6.90(4.71,7.84),Z=-4.497,P=0.000;Hb:121±17 VS 130±13,t=-3.496,P=0.001;PLT:215±82 VS 242±63,t=-2.147,P=0.034;HDL:1.18(1.04,1.36)VS 1.47(1.33,1.67),Z=-5.935,P=0.000.(8)From the OCTA examination parameters,there is no correlation between the blood concentration of hydroxychloroquine and FAZ size,SCP density(P>0.05).Analyzing the correlation between the administration of hydroxychloroquine and various parameters in the macular area,it was found that the cumulative dose of hydroxychloroquine is positively correlated with the circumference and area of FAZ(r_s=0.603,P<0.05、r_s=0.737,P<0.05).The duration of hydroxychloroquine treatment is positively correlated with the circumference and area of FAZ(r_s=0.676,P<0.05、r_s=0.860,P<0.05).Conclusions:(1)The therapeutic effect of hydroxychloroquine on systemic lupus erythematosus is positive.The larger the follow-up dose,the higher the blood concentration of hydroxychloroquine,and the lower the disease activity under higher blood concentration of hydroxychloroquine.The blood concentration of hydroxychloroquine is associated with an increase in white blood cells,hemoglobin,and platelets,as well as a decrease in ESR,CRP,and Ig G,which may reduce disease activity through the above factors.Hydroxychloroquine may affect lipid metabolism by increasing HDL levels,thereby indirectly reducing the risk of cardiovascular disease.(2)From the OCTA examination results,no adverse effects of hydroxychloroquine blood concentration on the vessels in the macular area were observed.The cumulative dose and medication time of hydroxychloroquine are related to the circumference and area of FAZ.Therefore,early OCTA examination can help detect the loss of retinal vessels as soon as possible. |
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