系统性红斑狼疮患者皮肤血管炎的临床研究  

Clinical characteristics of systemic lupus erythematosus patients with cutaneous vasculitis

作　　者：陈圣安[1] 杨凡萍 薛海玉[1] 骆肖群[1] 

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中华皮肤科杂志》2017年第6期439-442,共4页Chinese Journal of Dermatology

摘　　要：目的比较有无皮肤血管炎表现的系统性红斑狼疮（SLE）患者的临床和实验室特点，探讨SLE患者皮肤血管炎与实验室指标以及内脏损伤的关系。方法分析2011年7月至2014年10月复旦大学附属华山医院皮肤科收治的152例有皮肤症状的SLE患者临床和实验室资料，并将其分为四肢末端血管炎组和网状青斑组。应用logistic回归模型分析皮肤血管炎与临床和实验室各变量的关系。结果152例SLE患者中，62例（41％）有皮肤血管炎表现（包括55例四肢末端血管炎和7例网状青斑），90例（59％）无皮肤血管炎。四肢末端血管炎组患者年龄（30．54±12．67）岁、24h尿蛋白定量和血清尿素异常升高分别为39．39％和2．08％，均明显低于无血管炎组年龄（37．77±12．17）岁，64．00％和16．43％，而女性比例（98．18％）、头颅MRI异常（37．50％）、贫血（87．03％）、抗核糖体P蛋白抗体阳性的比例（77．77％）及SLEDAI指数（14．71±7．75）均明显高于无血管炎组（84．44％、12．19％、70．93％、53．65％、10．68±5．61），差异有统计学意义（均P〈0．05），而C3降低的比例与无血管炎组相比差异无统计学意义（P=0．362）。网状青斑组患者c3降低的比例（28．57％）显著低于无血管炎组（79．76％，P=0．008），其他指标与无血管炎组相比，差异无统计学意义（均P〉0．05）。体质指数（BMI）、肺功能异常及其他实验室指标在四肢末端血管炎组、网状青斑组及无血管炎组间差异无统计学意义（均P〉0．05）。logistic回归分析显示，在排除了年龄和性别的影响后，皮肤血管炎与头颅MRI异常（OR=4．24，95％C1：1．17—16．13，P=0．028）及抗核糖体P蛋白抗体阳性（OR=3．97，95％CI：1．86-8．47，P=0．0004）呈显著正影响的关系；与24h尿蛋白异常呈显著负影响的关系（OR=0．25，95％CI：0．09～0．69，P=0．Objective To compare clinical and laboratory characteristics between systemic lupus erythematosus （SLE） patients with and without cutaneous vasculitis, and to investigate the correlation of cutaneous vasculitis with severe visceral involvement and laboratory biomarkers. Methods A total of 152 SLE patients with various skin manifestations were enrolled from Department of Dermatology of Huashan Hospital affiliated to Fudan University from July 2011 to October 2014. The clinical and laboratory data were collected and retrospectively analyzed. SLE patients with cutaneous vasculitis were divided into upper/lower extremity vasculitis group and livedo reticularis group. A logistic regression model was used to analyze the correlation between cutaneous vasculitis and various clinical and laboratory variables. Results Of 152 SLE patients, 62 （41%） presented with cutaneous vasculitis, including 55 with upper/lower extremity vasculitis and 7 with livedo reticularis, and 90 （59%） did not have cutaneous vasculitis. Patients with upper/lower extremity vasculitis showed significantly younger age （30.54 ± 12.67 years vs. 37.77 ± 12.17 years）, and lower prevalence of aberrantly elevated 24- hour protein excretion （39.39% vs. 64.00% ） and serum urea level （2.08% vs. 16.43%）, but significantly higher percentage of females （98.18% vs. 84.44%）, higher proportions of patients with abnormal brain MRI （37.5% vs. 12.19% ）, anemia （87.03% vs. 70.93%） and positive anti- ribosomal P protein antibodies （77.77% vs. 53.65%）, and higher SLE disease activity index （SLEDAI） （14.71 ± 7.75 vs. 10.68 ± 5.61） than those without vasculitis （all P 〈 0.05 ）. The proportion of patients with decreased C3 level did not differ between patients with upper/lower extremity vasculitis and those without cutaneous vasculitis （P = 0.362）, but was significantly lower in the patients with livedo reticularis than in those without cutaneous vasculitis （28.57% vs. 79.76%, P = 0.008）. However, no significa

关 键 词：红斑狼疮 系统性 系统性血管炎 网状青斑 中枢神经系统 自身抗体 

分 类 号：R593.241[医药卫生—内科学]