系统性红斑狼疮伴淋巴细胞减少患者临床特征

发布时间：2018-12-11 18:30

【摘要】：目的本文通过分析SLE患者淋巴细胞减少与临床表现、感染、实验室检查及疾病活动度的关系,进一步探索淋巴细胞减少的原因和意义。方法采取回顾性病例对照研究的方法,选取2013年6月至2015年12月山东省立医院入院患有SLE病人193例,根据患者有无淋巴细胞减少将其分为淋巴细胞减少组和对照组。临床资料涵盖病患的一般情况、临床表现(神经精神症状、血管炎、肾损害、肌损害、脱发、皮疹、发热、实验室检查结果包括血常规、24小时尿蛋白、自身抗体、免疫球蛋白、补体等,就两组以上所提及的各种临床表现和各类实验室检查结果进行单因素及多因素Logistic回归分析。结果两组病人的基本情况无统计学差异。病例组神经精神症状、心包炎、皮疹、黏膜溃疡、发热、感染、细菌感染、白细胞减少、中性粒细胞减少、贫血、血小板减少、贫血合并血小板减少的发病率高于对照组,病例组SLEDAI积分高于对照组,病例组抗dsDNA抗体、AnuA、抗sm抗体、AHA、抗U1RNP抗体水平高于对照组,血清C3水平低于对照组;病例组AHA、抗U1RNP抗体阳性率高于对照组。多因素Logistic回归分析提示皮疹,抗U1RNP抗体水平升高/阳性,白细胞总数减少,贫血,血小板计数减少,贫血合并血小板减少是淋巴细胞减少的危险因素。结论淋巴细胞减少是SLE患者常见的血液系统受损表现之一;SLE淋巴细胞减少与神经精神症状、心包炎、皮疹、黏膜溃疡症状相关。多种自身抗体与SLE淋巴细胞减少相关,其中抗U1RNP抗体是淋巴细胞减少的危险因素。SLE合并其他血细胞受累的患者,更易出现淋巴细胞减少。SLE病人淋巴细胞减少比白细胞减少与SLEDAI积分增高之间有更好的相关性,这说明淋巴细胞减少可以用作反应狼疮活动的一个简便、低廉的指标在临床上使用。SLE合并淋巴细胞减少症和感染尤其是细菌感染相关。
[Abstract]:Objective to explore the causes and significance of lymphocytopenia in patients with SLE by analyzing the relationship between lymphocytopenia and clinical manifestations, infection, laboratory examination and disease activity. Methods A retrospective case-control study was conducted in 193 patients with SLE in Shandong Provincial Hospital from June 2013 to December 2015. The patients were divided into two groups: lymphocytopenia group and control group according to whether the patients had lymphocytopenia or not. Clinical data covered the patient's general situation, clinical manifestations (neuropsychiatric symptoms, vasculitis, kidney damage, muscle damage, alopecia, rash, fever, laboratory findings including blood routine, 24 hours urine protein, autoantibodies, Immunoglobulin, complement, and so on. Univariate and multivariate Logistic regression analysis was carried out on all kinds of clinical manifestations and laboratory results mentioned above in the two groups. Results there was no statistical difference between the two groups. The incidence of neuropsychiatric symptoms, pericarditis, rash, mucosal ulcer, fever, infection, bacterial infection, leukopenia, neutropenia, anemia, thrombocytopenia, anemia and thrombocytopenia were higher in the case group than in the control group. The SLEDAI score in the case group was higher than that in the control group, and the levels of anti dsDNA antibody, AnuA, anti sm antibody and AHA, anti U1RNP antibody in the case group were higher than those in the control group, and the serum C3 level was lower than that in the control group. The positive rate of AHA, anti U1RNP antibody in the case group was higher than that in the control group. Multivariate Logistic regression analysis showed that rash, increased / positive level of anti U1RNP antibody, total leukopenia, anemia, thrombocytopenia and anemia combined with thrombocytopenia were risk factors of lymphocytopenia. Conclusion Lymphocytopenia is one of the common manifestations of blood system damage in patients with SLE and SLE lymphocyte reduction is associated with symptoms of neuropsychiatric symptoms pericarditis skin rash and mucosal ulcer. A variety of autoantibodies are associated with SLE lymphocytopenia, among which anti-U1RNP antibodies are a risk factor for lymphocytopenia. Lymphocytopenia is more likely to occur in patients with SLE. There is a better correlation between lymphocytopenia and increased SLEDAI scores in SLE patients, suggesting that lymphocytopenia can be used as a simple response to lupus activity. SLE associated with lymphocytopenia and infection, especially bacterial infection.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.241

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