初发系统性红斑狼疮相关血小板减少症的临床特点及治疗随访分析

张莉莉; 张冬梅; 谢长好

doi:10.16766/j.cnki.issn.1674-4152.001910

初发系统性红斑狼疮相关血小板减少症的临床特点及治疗随访分析

doi: 10.16766/j.cnki.issn.1674-4152.001910

蚌埠医学院第一附属医院风湿免疫科，安徽蚌埠 233004

基金项目:

安徽省高校省级自然科学研究重点项目 KJ2019A0319

安徽省自然科学基金面上项目 1608085MH215

详细信息

通讯作者:
谢长好, E-mail: uglboy2002@126.com

中图分类号: R593.241 R558.2
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出版历程
- 收稿日期: 2020-09-07
- 网络出版日期: 2022-02-16

Clinical characteristics, treatment and follow-up analysis of newly diagnosed systemic lupus erythematosus associated thrombocytopenia

Department of Rheumatology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析初发系统性红斑狼疮(systemic lupus erythematosus，SLE)相关血小板减少症(thrombocytopenia，TP)的临床特点、治疗及血小板(platelet，PLT)计数恢复情况。方法回顾2012年4月—2018年12月于蚌埠医学院第一附属医院风湿免疫科住院的初发SLE患者309例，根据PLT计数，将患者分为TP组(83例)和无TP组(226例)，采用t检验、χ²检验及Mann-Whiney U检验分析2组间临床表现和实验室指标，对差异有统计学意义的指标进行多因素logistic回归分析。再进一步分析TP组的治疗及PLT计数恢复情况。结果 309例初发SLE患者中，TP发生率为26.9%。TP组狼疮肾炎、白细胞减少症、贫血、抗SSB抗体阳性的发生率高于无TP组(均P < 0.05)，关节炎的发生率、补体C3水平低于无TP组(均P < 0.05)，TP组SLEDAI评分高于无TP组(P < 0.05)。多因素logistic分析提示贫血为TP的危险因素(P < 0.05)，而关节炎为TP的保护性因素(P < 0.05)。TP的院内缓解率为77.2%(61/79)。结论 TP是初发SLE患者血液系统损害常见表现之一，常伴有贫血、狼疮肾炎，大部分患者对治疗反应良好，院内缓解率较高。
- 系统性红斑狼疮 /
- 血小板减少 /
- 初发
Abstract: Objective To analyse the clinical features, treatment and platelet (PLT) count recovery of newly diagnosed systemic lupus erythematosus (SLE) associated thrombocytopenia (TP). Methods A total of 309 newly diagnosed SLE patients hospitalised in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Bengbu Medical College from April 2012 to December 2018 were reviewed. According to PLT count, the patients were divided into TP group and non-TP group. The clinical manifestations and laboratory indexes between the two groups were analysed by t test, χ² test and Mann-Whiney U test. The statistically significant indexes were selected for multivariate logistic analysis. The treatment and PLT count recovery of TP group were further analysed. Results The incidence of TP was 26.9% among 309 patients with newly diagnosed SLE. The incidences of lupus nephritis, leukopenia, anaemia and positive anti-SSB antibody in the TP group were higher than those in the non-TP group. The incidence of arthritis and the level of complement C3 in the TP group were lower than those in the non-TP group. The SLEDAI score in the TP group was higher than that in the non-TP group. Multivariate logistic analysis showed that anaemia was a risk factor for TP and arthritis was a protective factor for TP. The in-hospital remission rate of TP was 77.2% (61/79). Conclusion TP is one of the common manifestations of haematological damage in patients with newly diagnosed SLE, which is often accompanied by anaemia and lupus nephritis. Most of the patients respond well to treatment and have a high remission rate in hospital.
- Systemic lupus erythematosus /
- Thrombocytopenia /
- Newly diagnosed

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表 1 2组临床表现、实验室检查指标比较(例)

组别	例数	NPSLE		LN		关节炎		抗ds-DNA抗体		抗Sm抗体		抗SSB抗体		ACL		β2-GP		白细胞减少		贫血		补体C3
组别	例数	有	无	有	无	有	无	阳性	阴性	阳性	阴性	阳性	阴性	阳性	阴性	阳性	阴性	有	无	有	无	补体C3
TP组	83	3	80	46^b	36	27	56	65	18	39^e	41	31	52	3^h	38	3^h	38	54	29	68	15	0.34(0.20, 0.48)
无TP组	226	4	224	86^c	138	131	95	169^d	54	128^f	81	56^g	163	4ⁱ	50	12^j	47	114	112	141	85	0.46(0.35, 0.63)
χ²值		0.286^a		7.671		15.717		0.215		3.702		4.072		0.001^a		3.217		5.229		10.587		-4.252
P值		0.593		0.006		0.001		0.643		0.054		0.044		0.999		0.073		0.020		0.001		0.001
注：NPSLE为神经精神狼疮；LN为狼疮肾炎；ACL为抗心磷脂抗体；β₂-GP1为抗β₂糖蛋白1抗体；^a为采用连续性校正χ²检验；^b实际统计82人；^c实际统计224人；^d实际统计223人；^e实际统计80人；^f实际统计209人；^g实际统计219人；^h实际统计41人；ⁱ实际统计54人；^j实际统计59人。

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表 2 初发SLE相关TP危险因素的二元logistic回归分析

项目	β	SE	Wald χ²	P值	OR值	95%CI
关节炎	-0.927	0.297	0.759	0.002	0.396	0.221~0.708
贫血	0.749	0.374	4.018	0.045	2.115	1.017~4.398
狼疮肾炎	0.174	0.363	0.229	0.632	1.190	0.584~2.422
抗SSB抗体	0.400	0.306	1.712	0.191	1.492	0.819~2.719
白细胞减少	0.496	0.305	2.654	0.103	1.643	0.904~2.985
补体C3	-1.663	1.039	2.560	0.110	0.190	0.025~1.454
SLEDAI	0.027	0.033	0.705	0.401	1.028	0.964~1.096

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参考文献(20)

[1]	张雪, 孙娟, 谢长好, 等. 心理干预对育龄期系统性红斑狼疮患者的影响[J]. 中华全科医学, 2018, 16(10): 1762-1765. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201810049.htm
[2]	钮凌颖, 周康兴, 王红. 系统性红斑狼疮患者合并感染临床特点及影响因素的分析[J]. 中国临床研究, 2016, 29(8): 1090-1092. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201608023.htm
[3]	JUNG J H, SOH M S, AHN Y H, et al. Thrombocytopenia in systemic lupus erythematosus: clinical manifestations, treatment, and prognosis in 230 patients[J]. Medicine, 2016, 95(6): 1-7. http://repository.ajou.ac.kr/bitstream/201003/15199/1/26871854.pdf
[4]	MU L, HAO Y, FAN Y, et al. Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus[J]. Lupus, 2018, 7(10): 1742-1752. http://www.ncbi.nlm.nih.gov/pubmed/30060721
[5]	CHEN Z, ZHONG H, DONG G. Thrombocytopenia as a prognostic marker for systemic lupus erythematosus: a systematic review and meta-analysis[J]. Am J Med Sci, 2019, 357(6): 461-467. doi: 10.1016/j.amjms.2019.03.002
[6]	LIU Y, CHEN S, SUN Y, et al. Clinical characteristics of immune thrombocytopenia associated with autoimmune disease: a retrospective study[J]. Medicine(Baltimore), 2016, 95(50): 1-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268034/pdf/md-95-e5565.pdf
[7]	龙现明, 蔡成森, 周欣, 等. 系统性红斑狼疮继发难治性血小板减少的临床特征分析[J]. 中华风湿病学杂志, 2020, 24(3): 170-174. https://cdmd.cnki.com.cn/Article/CDMD-10023-1017225065.htm
[8]	姜楠, 赵久良, 李梦涛, 等. CSTAR注册研究: 初治系统性红斑狼疮相关血小板减少症的临床特点[J]. 中华临床免疫和变态反应杂志, 2017, 11(2): 101-105. https://www.cnki.com.cn/Article/CJFDTOTAL-OZHL201702001.htm
[9]	PAWLAK-BUS K, LESZCZYNSKI P, KOKOT M, et al. Thrombocytopenia resistent to standard therapy in lupus patients-analysis of 3 cases and clinical statement[J]. Ann Agric Environ Med, 2017, 25(2): 229-233. doi: 10.26444/aaem/80708
[10]	MIRANDA-HERNANDEZ D, CRUZ-REYES C, MONSEBAIZ-MORA C, et al. Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality[J]. Lupus, 2017, 26(6): 640-645. doi: 10.1177/0961203316672926
[11]	JIANG N, LI M, ZHANG M, et al. Chinese SLE Treatment and Research group(CSTAR) registry: Clinical significance of thrombocytopenia in Chinese patients with systemic lupus erythematosus[J]. PLoS One, 2019, 14(11): 1-16. http://www.ncbi.nlm.nih.gov/pubmed/31747435
[12]	ARTIM-ESEN B, CENE E, SAHINKAYA Y, et al. Autoimmune haemolytic anaemia and thrombocytopaenia in a single-centre cohort of patients with systemic lupus erythematosus from Turkey: clinical associations and effect on disease damage and survival[J]. Lupus, 2019, 28(12): 1480-1487. doi: 10.1177/0961203319877245
[13]	ABDEL GALIL S M, EDREES A M, AJEEB A K, et al. Prognostic significance of platelet count in SLE patients[J]. Platelets, 2017, 28(2): 203-207. doi: 10.1080/09537104.2016.1214253
[14]	LINNEMANN B. Antiphospholipid syndrome-an update[J]. Vasa, 2018, 47(6): 451-464. doi: 10.1024/0301-1526/a000723
[15]	KOH J H, PARK E K, LEE H N, et al. Clinical characteristics and survival of 413 patients with systemic lupus erythematosus in southeastern areas of South Korea: A multicenter retrospective cohort study[J]. Int J Rheum Dis, 2020, 23(1): 92-100. http://d.wanfangdata.com.cn/periodical/807ff6d2ea0294a7dfe75020b6e630a5
[16]	TEKE H U, CANSU D U, KORKMAZ C. Detailed features of hematological involvement and medication-induced cytopenia in systemic lupus erythematosus patients: single center results of 221 patients[J]. Eur J Rheumatol, 2017, 4(2): 87-92. http://pubmedcentralcanada.ca/pmcc/articles/PMC5473461/
[17]	GONZLEZ-NARANJO L A, BETANCUR O M, ALARCN G S, et al. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort[J]. Semin Arthritis Rheum, 2016, 46(6): 675-683. http://www.ncbi.nlm.nih.gov/pubmed/26698222
[18]	ZHAO L, XU D, QIAO L, et al. Bone marrow megakaryocytes may predict therapeutic response of severe thrombocytopenia in patients with Systemic Lupus Erythematosus[J]. J Rheu matol, 2016, 43(6): 1038-1044. http://www.ncbi.nlm.nih.gov/pubmed/27134253
[19]	LI J, PAN Z, LIU H, et al. Retrospective analysis of the risk of hemorrhage associated with moderate and severe thrombocytopenia of 173 patients with systemic lupus erythematosus[J]. Medicine(Baltimore), 2018, 97(27): 1-5. http://europepmc.org/abstract/MED/29979417
[20]	MOK C C, HO L Y, TSE S M, et al. Prevalence of remission and its effect on damage and quality of life in Chinese patients with systemic lupus erythematosus[J]. Ann Rheum Dis, 2017, 76(8): 1420-1425. http://europepmc.org/abstract/MED/28432050