系统性红斑狼疮并发贫血的类型分析  

Etiological profile of anemia in patients with systemic lupus erythematosus

作　　者：罗雄燕[1] 吴凤霞[1] 武丽君[2] 唐中[1] 刘宁涛[3] 宋小芸[2] 库尔班江[2] 杨明辉[1] 周京国[1] 赵岩[4] 曾小峰[4] 袁国华[1] 

机构地区：[1]川北医学院风湿免疫研究所,四川南充637000 [2]新疆维吾尔自治区人民医院风湿科 [3]遂宁市中心医院风湿科 [4]北京协和医院风湿科

出　　处：《中华临床医师杂志（电子版）》2010年第10期25-29,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：卫生部重大疾病研究资助项目(2008BA159B02)

摘　　要：目的分析系统性红斑狼疮(SLE)并发贫血的类型,并探讨其易于发生的危险因素。方法根据贫血相关实验室指标和骨髓检查结果对239例SLE患者中并发贫血患者的贫血类型进行分析,并与无贫血的SLE患者的临床和实验室资料进行对比分析。结果 239例SLE患者中有127例(53.1%)发生贫血,对127例中89例资料完整患者的贫血类型分析结果显示,慢性疾病性贫血(ACD)有35例(39.3%),缺铁性贫血(IDA)有32例(36.0%),自身免疫性溶血性贫血(AIHA)有21例(23.6%),其他类型贫血9例(10.1%)。同时有上述2种或2种以上类型贫血者7例(7.9%)。贫血程度以AIHA最为严重,其次为IDA,ACD则多为轻度贫血。AIHA和ACD以正细胞正色素性贫血为主,分别占90.5%和85.7%,而IDA则以小细胞低色素贫血为主,占87.5%。与34例无贫血的SLE患者对照,并发AIHA的患者关节炎、浆膜炎的发生率更高(P均<0.05),肾脏损害程度更重(P<0.05),补体C3水平明显降低(P<0.05),SLE病情活动指数(DAI)积分较无贫血组明显增高(P<0.05),而ACD和IDA患者合并白细胞减少者明显多于无贫血组患者(P<0.05),合并血小板减少和ANA滴度在AIHA、ACD和IDA患者均显著高于无贫血的SLE患者(P均<0.05)。结论 SLE并发的贫血以ACD和IDA常见,其次为AIHA,且多见于活动性病情严重的患者。在不同类型的贫血患者并发白细胞和血小板减少者均高于无贫血患者,提示SLE中不同血细胞损害可能存在部分共同病理机制。Objective To study the prevalence of different types of anemia in patients with systemic lupus erythematosus （SLE） and their associations with immunological and clinical parameters.Methods Eighty-nine SLE patients with anemia from among a total of 239 consecutive SLE patients were enrolled into the study.Standard hematological tests,bone marrow examinations and immunological tests were performed,the clinical and laboratory data in patients with different types of anemia were compared with patients without anemia.Results The identified causes in 89 SLE patients with anemia were anemia of chronic disease （ACD）[n=35（39.3%）],iron deficiency anemia （IDA） [n=32（36.0%）],autoimmune hemolytic anemia （AIHA） [n=21（23.6%）] and other causes [n=9（10.1%）].In 7 patients,the anemia had two or more causes.The severity of anemia was more severe in patients with AIHA and IDA.90.5% of AIHA and 85.7% of ACD patients presented as normocytic anemia,whereas 87.5% of IDA patients presented as microcytic anemia.In comparison with patients without anemia,more patients with AIHA had arthritis（P0.05）,serositis（P0.05）,severe renal damage（P0.05）,lower serum C3 levels（P0.05）,and higher SLEDAI scores（P0.05）.While,leucopenia was occurred more frequently in patients with ACD（P0.05） and IDA（P0.05）.Thrombocytopenia and increased ANA titer were detected more often in patients with AIHA,ACD and IDA,as compared with patients without anemia.Conclusions Anemia in SLE usually takes the form of ACD and IDA,AIHA is more likely developed in patients with active and severe disease.The increased incidence of leucopenia and thrombocytopenia in patients with anemia suggests that common mechanism might be partially involved in the damage of different blood cells in SLE.

关 键 词：红斑狼疮 系统性 贫血 溶血性 自身免疫性 贫血 缺铁性 

分 类 号：R593.241[医药卫生—内科学]