系统性红斑狼疮血液系统损害与疾病预后分析  

The relationship between impairment of hematological system and prognosis in systemic lupus erythematosus

作　　者：张学增 张育 孙凌云[2] 邹耀红[3] 潘文友[4] 王向党[5] 潘解萍[6] 张缪佳[7] 谭魁麟[8] 李晶[9] 陈志伟[10] 丁翔[11] 钱先[12] 达展云[13] 陶娟[14] 王美美[15] 

机构地区：[1]扬州大学临床医学院风湿免疫科,225001 [2]南京大学医学院附属鼓楼医院风湿免疫科 [3]江苏省无锡市人民医院风湿免疫科 [4]江苏省淮安市第一人民医院免疫风湿科 [5]江苏省徐州市第四人民医院风湿免疫科 [6]江苏省常州市第一人民医院免疫风湿科 [7]江苏省人民医院风湿免疫科 [8]江苏省镇江市第一人民医院风湿免疫科 [9]江苏大学附属医院风湿科 [10]苏州大学附属第一医院风湿科 [11]江苏省连云港市第一人民医院风湿免疫科 [12]江苏省中医院风湿免疫科 [13]南通大学附属医院风湿免疫科 [14]江苏省无锡市中医院风湿科 [15]东南大学附属中大医院风湿免疫科

出　　处：《中华风湿病学杂志》2011年第2期101-104,共4页Chinese Journal of Rheumatology

摘　　要：目的 分析系统性红斑狼疮（SLE）血液系统损害与疾病活动情况、免疫学指标的异常及疾病预后相关性。方法 总结江苏省1999-2009年间首次住院SLE患者的临床及实验室资料，观察血液系统损害情况，并分析了血液系统损害与SLE疾病活动情况、免疫学指标及SLE患者病死率间的关系。统计学处理采用χ^2检验。结果 1958例SLE患者纳入研究范围，其中女性患者1836例，男性患者122例。所有SLE患者中，1549例（79．1％）患者合并血液系统损害，其中贫血占62．3％，白细胞减少占45．5％，血小板减少占29．4％；轻、中、重度活动组患者血液学损害率均高于基本无活动组（P=0．01和P〈0．01）；血液系统损害发生率在红细胞沉降率、补体C3、抗双链DNA（dsDNA）抗体阳性组高于阴性组（P〈0．01）；有166例患者在随访中死亡，其中因重症感染死亡占38．6％，因肾功能衰竭死亡占22．9％，因神经系统损害死亡占15．1％，心血管疾病占10．2％，其他死因占13．3％。死亡病例中存在血液系统损害占91．6％，无血液系统损害占8．4％，血液系统损害率在死亡患者中明显增高（P〈0．01）。结论 血液系统是SLE最常受累的系统之一，其中以贫血最为常见，血液系统损害与狼疮病情活动密切相关；免疫性指标异常的患者容易继发血液系统的损害；重症感染是SLE患者死亡的主要原因，存在血液系统损害的SLE患者病死率高于非血液系统损害的SLE患者。Objective To explore the relationship between the impairment of hematological system and disease activity, immunological parameters, and the prognosis of systemic lupus erythematosus （SLE）. Methods The clinical and laboratory data of in-patients with SLE in Jiangsu Province were investigated and all patients were hospitalized between 1999-2009. The impairment of hematological system was assessed and the relationship between hematological system damage and disease activity, immunological parameters, mortality rate of patients with SLE were analyzed. Statistic method used was X^2 test. Results One thousand nine hundred and fifty eight cases of SLE were included in the study, in which, 1836 were female and 122 were male. One thousand five hundred and forty nine （79.1%） patients complicated with hematological system damage, 62.3% were anemia, 45.5% with leucopenia and 29.4% with thrombocytopenia. There were significant, differences in hematological system damage rate among patients with mild activity group, moderate activity group, severe activity group and almost no activity group, compared respectively with ahnost no activity group. The P values were P=0.01 and P〈0.01 respectively. The incidence of hematological system damage in elevated ESR, low complement C3 level,anti-dsDNA antibody group was higher than that in patients who had normal ESR, complement C3 level and anti-dsDNk group. （P〈O.O1）. During follow-up, 166 patients died, of which the mortality rate （91.6%） in patients had hematological system damage, was obviously higher than those without hematological damage （8.4%） （P〈0.01）. Among the 166 deceased patients, 38.6% died of severe infection, 22.9% died of renal failure, 15.1% died of nervous system damage, 10.2% died of cadiovaseular damage and 13.3% died from other causes. Conclusion Hematological system is one of the most commonly involved system in patients with SLE, of which anemia is the most common, and the incidence of leukopenia follows. The impairment of hematological

关 键 词：红斑狼疮 系统性 预后 血液系统损害 

分 类 号：R593.241[医药卫生—内科学]