【作者】 陈敏；

【导师】 向阳；

【作者基本信息】 大连医科大学 ， 内科学（专业学位）， 2021， 硕士

【摘要】 目的:系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)是一种自身免疫异常引起的多脏器多系统功能损害性疾病,临床表现可涉及多个系统,尤以血液系统为著,其中,淋巴细胞减少是SLE患者最常见的血液系统损害表现之一。本研究以SLE患者为研究对象,以淋巴细胞减少为切入点,开展SLE伴淋巴细胞减少患者的临床特点研究,以期进一步提高临床医生对SLE伴淋巴细胞减少的认识,可为临床SLE的诊治提供新的医学证据。方法:采用回顾性研究,收集2010年3月～2020年8月在中国人民解放军联勤保障部队第九六七医院血液科住院治疗的初治SLE患者156例,依据淋巴细胞<1×10~9/L与否,将患者分为淋巴细胞减少组与淋巴细胞正常组,以一般资料、临床表现、血常规、白蛋白、球蛋白、自身免疫抗体谱为观察指标开展研究。结果:1、纳入本项研究的SLE患者共156例,其中女142例,男14例,中位年龄42岁(19～65岁)。主要临床表现为发热、浆膜腔积液、面部红斑、光过敏、口腔溃疡、关节疼痛、肾脏病变、血液系统损害、低白蛋白血症、高球蛋白血症,以血液系统损害最为多见,发生率为52.6%。2、156例SLE患者血液系统损害以贫血最为常见,白细胞减少、淋巴细胞减少次之。3、淋巴细胞计数减少组、淋巴细胞计数正常组年龄、性别、发热、面部红斑、口腔溃疡、关节疼痛、肾脏病变、高球蛋白血症发生率的差异均无统计学意义(P>0.05)。淋巴细胞计数减少组的患者浆膜腔积液、感染(主要为肺部感染)发生率明显高于淋巴细胞计数正常组,分别为38.2%、23.6%,且两组间的差异均有统计学意义(P<0.05);淋巴细胞计数减少组的SLE患者光过敏发生率明显低于淋巴细胞正常组,分别为7.3%和22.8%,且具有统计学意义(P<0.05)。4、淋巴细胞计数减少组、淋巴细胞计数正常组球蛋白、Ig A、Ig G、Ig M水平升高以及抗核抗体、抗双链DNA抗体、抗SSA抗体、抗SSB抗体、抗Ro52抗体、抗Sc170抗体、抗Jo-1抗体阳性、抗RNP抗体阳性的发生率的差异均无统计学意义(P>0.05)。淋巴细胞计数减少组的中位血清白蛋白低于正常参考值范围,两组的中位C3、C4均低于正常参考值范围,其余检测值均在正常范围内。淋巴细胞计数减少组的患者白细胞减少、血小板减少、贫血、白蛋白降低、C3降低、C4降低、抗Sm抗体、抗核糖体抗体、抗核小体抗体、抗组蛋白抗体阳性发生率明显高于淋巴细胞计数正常组,分别为61.8%、54.5%、34.5%、38.2%、80.5%、76.4%、90.9%、29.1%、36.4%、61.8%、54.5%,且两组间的差异均有统计学意义(P<0.05)。5、血小板减少、白细胞减少、抗Sm抗体阳性、补体C4降低、低白蛋白血症是SLE患者发生淋巴细胞减少的独立危险因素。结论:1、SLE常常累及多系统,血液系统位居首位。2、淋巴细胞减少是仅次于贫血的SLE患者最常见的血液系统损害表现。3、伴淋巴细胞减少的SLE患者更易出现浆膜积液、感染、白细胞减少、贫血、血小板减少、低白蛋白血症等临床表现,实验室检查以白蛋白降低、C3降低、C4降低、抗Sm抗体阳性、抗核小体抗体阳性、抗组蛋白抗体阳性、抗核糖体抗体阳性更为多见。4、血小板减少、白细胞减少、抗Sm抗体阳性、C4降低、低白蛋白血症是SLE患者发生淋巴细胞减少的独立危险因素。更多还原

【Abstract】 Objective:Systemic lupus erythematosus(SLE)is a disease,involving multiple organs and multiple systems dysfunction caused by autoimmune abnormalities.The clinical manifestations can involve multiple systems,especially the blood system.lymphocytopenia is one of the most common lesions in the blood system in the patients with SLE.In the study,the patients with newly diagnosed SLE accompanied by lymphopenia,were the as the research objects,and lymphopenias the breakthrough point to study the clinical characteristics in order to further improve the understanding of clinicians for the patients with SLE accompanied by lymphopenia,and provided new medical evidence for the diagnosis and treatment of SLE.Method:A retrospective study was conducted on 156 patients with newly diagnosed SLE who were hospitalized in the Hematology Department of the 967th Hospital of the Chinese people’s Liberation Army from March 2010 to August 2020.According to whether lymphocytes<1×10~9/L or not,patients were divided into lymphocytopenia group and normal lymphocyte group.The general data,clinical manifestations,blood routine,total protein,albumin,globulin and autoimmune antibody spectrum were used as observation indexes.Result:1、A total of 156 SLE patients were selected for the study,including 14 males and142 females,with a median age of 42 years(19-65 years).The main clinical manifestations were fever,serous cavity effusion,facial erythema,photoallergy,oral ulcer,joint pain,kidney disease,blood system damage,hypoalbuminemia,hyperglobulinemia,and the most common was blood system damage.with an incidence of 52.6%.2、In 156 SLE patients,anemia was the most common,followed by leukopenia and lymphopenia.3、There was no statistical significance in age,gender,fever,facial erythema,oral ulcer,joint pain,kidney disease and hyperglobulinemia between these two groups(P>0.05).The incidence of serosal cavity effusion and infection(mainly pulmonary infection)in the lymphopenia group was significantly higher than that in the normal group,which were 38.2%and 23.6%,respectively with statistical significance between the two groups(P<0.05).The incidence of photohypersensitivity in the lymphopenia group was lower than that of normal group,which were 7.3%and 22.8%,respectively,with statistical significance between the two groups(P<0.05)between two groups(P<0.05).4、There were no statistical significance between the two groups(P<0.05).In the incidence of elevated levels of globulin,Ig A,Ig G,Ig M,and positive anti-nuclear antibody,anti-double DNA antibody,anti-SSA antibody,anti-SSB antibody,anti-RO52 antibody,anti-SC170 antibody,anti-JO-1 antibody and anti-RNP antibody between the the lymphopenia group and the normal group(P>0.05).The median serum albumin of the lymphopenia group was below normal reference value,the median C3 and C4 of the two groups were also below normal reference value,and the other detection values were in the normal range.The incidence of leucopenia,thrombocytopenia,anemiaand decreased levels of albumin,C3,C4 and positive anti SM antibody,anti ribosomal antibody,anti nucleosome antibody and anti histone antibody in the lymphopenia group were significantly higher than those in the normal group,which were 61.8%,54.5%,34.5%,38.2%,80.5%,76.4%,90.9%and 29.1%,4%,61.8%,54.5%,respectively with statistical significance between the two groups(P<0.05).5、Thrombocytopenia,leukopenia,positive anti-Sm antibodies,decreased levels of C4 and hypoalbuminemia are independent risk factors for SLE patients with lymphopenia.Conclusion:1、SLE often involves multiple systems involving the blood system first.2、Lymphopenia is the most common manifestation of blood system damage in SLE patients after anemia.3、The patients with SLE lymphocytopenia accompanied by lymphocytopenia are subject to have serous effusion,infection,leukopenia,anemia,thrombocytopenia,hypoalbuminemia.Decreased albumin,total protein,C4 and positive Sm antibody,nucleosome antibody,anti histone antibody,ribosome antibody positive reduction is more commonin laboratory examination.4、Thrombocytopenia,leukopenia,positive anti-Sm antibody,decreased levels of C4 and hypoalbuminemia are independent risk factors for SLE patients with lymphopenia.更多还原