系统性红斑狼疮患者凝血-纤溶功能变化与疾病活动的关系  

Relationships between changes in coagulation and fibrinolysis function and disease activity in patients with systemic lupus erythematosus

作　　者：俞烜华[1] 刘昌泉 张莹 张伟桢 吕雪冰 李扬宇[4] 吴月萍 黄惠娟[5] YU Xuanhua;LIU Changquan;ZHANG Ying;ZHANG Weizhen;LYU Xuebing;LI Yangyu;WU Yueping;HUANG Huijuan(Department of Rheumatology,People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China;不详)

机构地区：[1]福建中医药大学附属人民医院风湿病科,福州350004 [2]福建中医药大学第二临床医学院 [3]福州市台江区茶亭街道社区卫生服务中心 [4]福建中医药大学附属人民医院检验科 [5]福建中医药大学附属人民医院治未病科

出　　处：《山东医药》2024年第30期24-28,共5页Shandong Medical Journal

基　　金：福建省教育厅资助项目(JT180226);福建省自然科学基金资助项目(2022J01851);福建省卫健委中青年骨干人才项目(2023GGA071)。

摘　　要：目的观察系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者凝血—纤溶功能变化,探讨其与SLE疾病活动指标及不同系统损害的关系。方法选择我院SLE患者109例及100例健康体检者,抽取外周静脉血,检测凝血—纤溶指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、纤维蛋白(原)降解产物(FDP)、D-2聚体(DD)]与SLE疾病活动指标[血沉(ESR)、补体(C)3、C4、抗双链DNA抗体(抗dsDNA抗体)、C反应蛋白(CRP)、免疫球蛋白G(IgG)、IgM、IgA],比较不同疾病活动度及不同系统损害的SLE患者血浆APTT、PT、TT、FIB、FDP、DD指标差异,采用pearson或Spearman秩相关分析法分析APTT、PT、TT、FIB、FDP、DD水平与SLE疾病活动指标的相关性;采用单因素及多因素Logistic回归分析法分析SLE患者疾病活动的影响因素。结果与健康体检者相比,SLE患者血浆PT、FIB、FDP、DD水平升高(P均<0.05);与非活动期[系统性红斑狼疮疾病活动度(SLEDAI)评分<5分]者比较,疾病活动期(SLEDAI评分≥5分)的SLE患者血浆FIB、FDP、DD水平高(P均<0.05)。与无肾脏病变者比较,出现肾脏病变的SLE患者血浆FIB、FDP、DD水平高(P均<0.05);与无间质性肺炎(ILD)者相比,存在ILD的SLE患者血浆FIB水平高(P<0.05);与未出现浆膜炎患者相比,出现浆膜炎的SLE患者血浆PT、APTT、FDP、DD水平高;与无血液系统受累者相比,存在血液系统受累的SLE患者血浆PT、APTT长(P均<0.05)。SLE患者血浆PT水平与ESR呈正相关、与C3呈负相关(P均<0.05);APTT与ESR、IgG、抗dsDNA抗体水平呈正相关,与C3、C4呈负相关(P均<0.05);FIB与ESR、IgG、C4、IgA水平及SLEDAI评分均呈正相关(P均<0.05)。SLE患者血浆DD与ESR、CRP、IgG、抗dsDNA抗体水平及SLEDAI评分呈正相关(P均<0.05);FDP与ESR、CRP、IgG、抗dsDNA抗体水平及SLEDAI评分呈正相关(P均<0.05)。单因素Logistic回归分析结果显示,FIB、ESR、IgA、IgG、抗dsDNA�Objective To observe the changes of coagulation and fibrinolysis function in patients with systemic lupus erythematosus(SLE),and to explore their relationships with the disease activity indicators and different system damage.Methods Peripheral venous blood was collected from 109 SLE patients and 100 healthy subjects in our hospital.Coagulation-fibrinolytic indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),fibrin degradation products(FDP),D-2 polymers(DD)]and SLE disease activity indexes[erythrocyte sedimentation rate(ESR),complement(C)3,C4,anti-double-stranded DNA(anti-dsDNA)antibody,Creactive protein(CRP),immunoglobulin G(IgG),IgM,and IgA]were detected.The plasma APTT,PT,TT,FIB,FDP,and DD in SLE patients with different disease activity and different system damage were compared.Pearson or Spearman rank correlation analysis was used to analyze the correlations between APTT,PT,TT,FIB,FDP,DD levels and disease activity indicators.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of disease activity in SLE patients.Results Compared with healthy subjects,the levels of PT,FIB,FDP and DD in SLE patients increased(all P<0.05);compared with non-active SLE patients(SLEDAI score<5),SLE patients with active SLE(SLEDAI score≥5)had higher levels of FIB,FDP and DD(all P<0.05).The levels of FIB,FDP and DD in SLE patients with renal lesions were higher than those without renal lesions(all P<0.05).The plasma FIB level of SLE patients with interstitial lung disease(ILD)was higher than that of patients without ILD(all P<0.05).Compared with patients without serositis,SLE patients with serositis had higher plasma PT,APTT,FDP and DD levels;compared with those without blood system involvement,SLE patients with blood system involvement had longer PT and APTT(both P<0.05).The plasma PT level was positively correlated with ESR and was negatively correlated with C3 in SLE patients(all P<0.05).APTT was positively correlated with ESR

关 键 词：凝血系统 纤溶系统 疾病活动 系统损害 红斑狼疮 系统性 

分 类 号：R593.24[医药卫生—内科学]