發(fā)布時(shí)間：2018-12-11 18:30

【摘要】：目的本文通過(guò)分析SLE患者淋巴細(xì)胞減少與臨床表現(xiàn)、感染、實(shí)驗(yàn)室檢查及疾病活動(dòng)度的關(guān)系,進(jìn)一步探索淋巴細(xì)胞減少的原因和意義。方法采取回顧性病例對(duì)照研究的方法,選取2013年6月至2015年12月山東省立醫(yī)院入院患有SLE病人193例,根據(jù)患者有無(wú)淋巴細(xì)胞減少將其分為淋巴細(xì)胞減少組和對(duì)照組。臨床資料涵蓋病患的一般情況、臨床表現(xiàn)(神經(jīng)精神癥狀、血管炎、腎損害、肌損害、脫發(fā)、皮疹、發(fā)熱、實(shí)驗(yàn)室檢查結(jié)果包括血常規(guī)、24小時(shí)尿蛋白、自身抗體、免疫球蛋白、補(bǔ)體等,就兩組以上所提及的各種臨床表現(xiàn)和各類(lèi)實(shí)驗(yàn)室檢查結(jié)果進(jìn)行單因素及多因素Logistic回歸分析。結(jié)果兩組病人的基本情況無(wú)統(tǒng)計(jì)學(xué)差異。病例組神經(jīng)精神癥狀、心包炎、皮疹、黏膜潰瘍、發(fā)熱、感染、細(xì)菌感染、白細(xì)胞減少、中性粒細(xì)胞減少、貧血、血小板減少、貧血合并血小板減少的發(fā)病率高于對(duì)照組,病例組SLEDAI積分高于對(duì)照組,病例組抗dsDNA抗體、AnuA、抗sm抗體、AHA、抗U1RNP抗體水平高于對(duì)照組,血清C3水平低于對(duì)照組;病例組AHA、抗U1RNP抗體陽(yáng)性率高于對(duì)照組。多因素Logistic回歸分析提示皮疹,抗U1RNP抗體水平升高/陽(yáng)性,白細(xì)胞總數(shù)減少,貧血,血小板計(jì)數(shù)減少,貧血合并血小板減少是淋巴細(xì)胞減少的危險(xiǎn)因素。結(jié)論淋巴細(xì)胞減少是SLE患者常見(jiàn)的血液系統(tǒng)受損表現(xiàn)之一;SLE淋巴細(xì)胞減少與神經(jīng)精神癥狀、心包炎、皮疹、黏膜潰瘍癥狀相關(guān)。多種自身抗體與SLE淋巴細(xì)胞減少相關(guān),其中抗U1RNP抗體是淋巴細(xì)胞減少的危險(xiǎn)因素。SLE合并其他血細(xì)胞受累的患者,更易出現(xiàn)淋巴細(xì)胞減少。SLE病人淋巴細(xì)胞減少比白細(xì)胞減少與SLEDAI積分增高之間有更好的相關(guān)性,這說(shuō)明淋巴細(xì)胞減少可以用作反應(yīng)狼瘡活動(dòng)的一個(gè)簡(jiǎn)便、低廉的指標(biāo)在臨床上使用。SLE合并淋巴細(xì)胞減少癥和感染尤其是細(xì)菌感染相關(guān)。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R593.241

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