原发性干燥综合征合并肝功能损害患者的临床特点及危险因素分析

高官莉; 魏晓龙; 申东北; 张应璐; 张树荣

doi:10.16766/j.cnki.issn.1674-4152.003791

原发性干燥综合征合并肝功能损害患者的临床特点及危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003791

高官莉^{1, 2},
魏晓龙¹,
申东北^{1, 2},
张应璐^{1, 2},
张树荣^1, ,

1.
中国人民解放军联勤保障部队第920医院、昆明医科大学第920医院临床学院消化内科，云南昆明 650032
2.
昆明医科大学研究生院，云南昆明 650500

基金项目:

云南省科技厅科技计划项目 202201AY070001-283

云南省科技厅科技计划项目 202101AU070087

详细信息

通讯作者:
张树荣，E-mail：zsr66@126.com

中图分类号: R593.2
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出版历程
- 收稿日期: 2024-02-20
- 网络出版日期: 2025-01-20

Clinical characteristics and risk factors of primary Sjögren's syndrome with liver function damage

GAO Guanli^{1, 2},
WEI Xiaolong¹,
SHEN Dongbei^{1, 2},
ZHANG Yinglu^{1, 2},
ZHANG Shurong^{1
, ,}

1.
Department of Gastroenterology, Clinical College of Kunming Medical University, 920th Hospital of the Joint Logistics Support Force of PLA, Kunming, Yunnan 650032, China

摘要

摘要: 目的分析原发性干燥综合征(pSS)合并肝功能及多系统损害患者的临床特征，以探究pSS肝功能损害的危险因素，为临床诊治提供新依据。方法选取2020年1月—2023年10月就诊于中国人民解放军联勤保障部队第920医院的92例确诊为pSS合并肝功能损害的患者为肝损组，另选取92例无肝功能损害的pSS患者作为非肝损组，分别收集2组患者的临床资料、辅助检查结果并行对比分析。结果 pSS肝损组合并血液系统受累(56.5%, 52/92)、骨关节受累(54.3%, 50/92)及甲状腺受累(23.9%, 22/92)者均显著多于pSS非肝损组[34.8%(32/92)、32.6%(30/92)、8.7%(8/92), P < 0.05]；肝损组合并2个以上系统受累(73.9%, 68/92)者亦显著多于非肝损组[55.4%(51/92), P < 0.05]。pSS肝损组CRP[6.45(2.83, 17.10)mg/L]、WBC[6.28(4.37, 9.51)×10⁹/L]水平均显著高于非肝损组[2.45(0.80, 8.40)mg/L、5.31(4.14, 6.74)×10⁹/L, P＜0.05]。pSS肝损组ANA阳性率(84.8%，78/92)、抗SSB阳性率(50.0%, 46/92)均显著高于pSS非肝损组[65.2%(60/92)、28.3%(26/92), P < 0.05]。Logistic回归分析显示，高CRP(OR=1.037，95% CI: 1.003~1.071，P＜0.05)、高WBC(OR=1.325，95% CI: 1.139~1.542，P＜0.01)、多系统受累(OR=2.262，95% CI: 1.039~4.925，P＜0.05)均为pSS患者合并肝功能损害的危险因素。结论肝功能损害的pSS患者常伴有多个系统损害，高CRP、WBC水平以及多系统受累均为pSS肝功能损害的危险因素。
- 干燥综合征 /
- 肝功能损害 /
- 多系统损害
Abstract: Objective To analyze the clinical characteristics of patients with primary Sjögren's syndrome (pSS) complicated with liver function and multi-system damage, and to explore the risk factors of liver function damage in pSS, so as to provide new basis for clinical diagnosis and treatment. Methods A total of 92 patients diagnosed with PSS and liver function damage admitted to the 920th Hospital of the Joint Logistics Support Force of PLA from January 2020 to October 2023 were selected as liver injury groups, and 92 patients with PSS patients who has no liver damage were selected as non-liver injury groups. The clinical data and auxiliary examination results of the two groups of patients were collated for comparison and analysis. Results The combination of liver damage and blood system involvement (56.5%, 52/92), joint and bone involvement (54.3%, 50/92), and thyroid involvement (23.9%, 22/92) in patients with pSS is significantly higher than in patients with pSS, however, without liver damage [34.8% (32/92), 32.6% (30/92), 8.7% (8/92), P < 0.05]. The proportion of patients with involvement of two or more systems in the liver injury group (73.9%, 68/92) is also significantly higher than that in the non-liver injury group (55.4%, 51/92, P < 0.05). The levels of CRP [6.45 (2.83, 17.10) mg/L] and WBC [6.28 (4.37, 9.51)×10⁹/L] in the pSS liver lesion group were found to be significantly higher than those in the non-liver injury group [2.45 (0.80, 8.40) mg/L, 5.31 (4.14, 6.74)×10⁹/L, P < 0.05]. The positive rates of ANA (84.8%, 78/92) and anti-SSB (50.0%, 46/92) in the pSS liver injury group were significantly higher than those in the pSS non-liver injury group [65.2% (60/92) and 28.3% (26/92), respectively, P < 0.05]. The logistic regression analysis demonstrated that elevated CRP (OR=1.037, 95% CI: 1.003-1.071, P < 0.05) and elevated WBC (OR=1.325, 95% CI: 1.139-1.542, P < 0.01), multi-system involvement (OR=2.262, 95% CI: 1.039-4.925, P < 0.05) were risk factors for liver function damage in pSS patients. Conclusion Patients with pSS who also have impaired liver function are frequently accompanied by multiple system impairment. Elevated CRP and WBC levels, in conjunction with multi-system involvement, constitute risk factors for pSS-related liver dysfunction.
- Sjögren's syndrome /
- Liver function impairment /
- Multisystem damage

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表 1 2组pSS患者基本特征比较

Table 1. Comparison of basic characteristics between two groups of pSS patients

组别	例数	性别(男/女, 例)	年龄(x ±s，岁)
肝损组	92	22/70	58.02±15.81
非肝损组	92	16/76	57.02±13.71
统计量		1.194^a	0.458^b
P值		0.275	0.647
注：^a为χ²值，^b为t值。

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表 2 2组pSS患者系统受累方面比较[例(%)]

Table 2. Comparison of systemic involvement between the two groups of pSS patients [case(%)]

组别	例数	口干、眼干	胃肠道受累	血液系统三系受累	肺部受累	心血管系统受累	甲状腺受累	骨关节受累	皮肤受累
肝损组	92	78(84.8)	48(52.2)	52(56.5)	22(23.9)	18(19.6)	22(23.9)	50(54.3)	10(10.9)
非肝损组	92	72(78.3)	44(47.8)	32(34.8)	14(15.2)	12(13.0)	8(8.7)	30(32.6)	6(6.5)
χ²值		1.299	0.348	8.762	2.210	1.434	7.806	8.846	1.095
P值		0.254	0.555	0.003	0.137	0.231	0.005	0.003	0.295

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表 3 2组pSS患者合并2个与2个以上(＞2个)系统受累情况比较[例(%)]

Table 3. Comparison of two or more systemic involvement between the two groups of pSS patients [cases (%)]

组别	例数	2个系统受累	2个以上系统受累
肝损组	92	24(26.1)	68(73.9)
非肝损组	92	41(44.6)	51(55.4)
χ²值		6.875
P值		0.009

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表 4 2组pSS患者实验室指标比较

Table 4. Comparison of laboratory indexes between the two groups of pSS patients

组别	例数	CRP [M(P₂₅, P₇₅)，mg/L]	ESR [M(P₂₅, P₇₅)，mm/h]	WBC [M(P₂₅, P₇₅)，×10⁹/L]	HB (x ±s，g/L)	PLT [M(P₂₅, P₇₅)，×10⁹/L]
肝损组	92	6.45(2.83, 17.10)	23.00(14.00, 48.75)	6.28(4.37, 9.51)	125.35±22.74	202.00(149.00, 244.00)
非肝损组	92	2.45(0.80, 8.40)	21.00(10.50, 36.50)	5.31(4.14, 6.74)	123.26±25.50	178.50(117.00, 264.00)
统计量		-4.126^a	-1.236^a	-2.514^a	0.586^b	-0.476^a
P值		< 0.001	0.217	0.012	0.559	0.634
注：^a为Z值，^b为t值。

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表 5 2组pSS患者自身抗体谱比较[例(%)]

Table 5. Comparison of autoantibody spectrum between the two groups of pSS patients [cases (%)]

组别	例数	ANA (+)	RF (+)	抗dsDNA (+)	抗SSA (+)	抗SSB (+)	抗AMA (+)
肝损组	92	78(84.8)	36(39.1)	12(13.0)	74(80.4)	46(50.0)	10(10.9)
非肝损组	92	60(65.2)	40(43.5)	10(10.9)	68(73.9)	26(28.3)	8(8.7)
χ²值		9.391	0.359	0.207	1.111	9.127	0.246
P值		0.002	0.594	0.650	0.292	0.003	0.620

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表 6 pSS合并肝功能损害影响因素的多因素logistic回归分析

Table 6. Multivariate Logistic regression analysis of influencing factors of pSS combined with liver function damage

变量	B	SE	Waldχ²	P值	OR值	95% CI
CRP	0.036	0.017	4.675	0.031	1.037	1.003~1.071
WBC	0.282	0.077	13.230	< 0.001	1.325	1.139~1.542
ESR	0.011	0.007	2.402	0.121	1.011	0.997~1.026
ANA(+)	-1.264	0.457	7.647	0.006	0.282	0.115~0.692
抗SSB(+)	-0.846	0.379	4.995	0.025	0.429	0.204~0.901
血液系统受累	-0.592	0.378	2.455	0.117	0.553	0.264~1.160
骨关节受累	-1.131	0.375	9.086	0.003	0.323	0.155~0.673
甲状腺受累	0.613	0.524	1.372	0.242	1.847	0.662~5.156
多系统受累	0.816	0.397	4.225	0.040	2.262	1.039~4.925

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