102例系统性红斑狼疮肝损害患者特点及危险因素分析

Analysis of clinical features and risk factors of 102 cases of lupus-associated hepatitis

目的:了解系统性红斑狼疮肝脏受累的特点,为临床诊断、鉴别诊断提供依据。方法:回顾性分析系统性红斑狼疮患者566例,比较狼疮性肝损害与无肝损害患者的一般情况、实验室检查结果及预后,并对狼疮性肝损害发生的危险因素进行分析。结果:566例系统性红斑狼疮患者中,狼疮性肝损害患者102例(18.02%)。狼疮性肝损害患者与无肝损害患者相比IgG较高[(18.65±8.64)g/L比(15.80±7.14)g/L,P<0.01],红细胞沉降率(ESR)较快[(22.85±9.30)mm/1h比(19.89±9.70)mm/1h,P<0.05],系统性红斑狼疮疾病活动指数(SLEDAI)较高(13.3±8.4比11.3±6.5,P<0.05),病程较短[(3.0±4.6)年比(4.2±6.0)年,P<0.05]。给予0.5～1mg/kg的甲泼尼龙和谷胱甘肽治疗后,70例(68.6%)患者在住院期间肝功能好转。Logistic回归分析显示,狼疮性肝损害的独立危险因素是神经精神系统受累以及年龄≤18岁。结论:系统性红斑狼疮肝脏损害并不少见,对于SLEDAI积分高、病程短、IgG高、ESR快的患者考虑为狼疮本身引起的肝脏损害,使用常规剂量的激素和谷胱甘肽治疗后预后较好,年龄≤18岁及精神神经系统受累是发生狼疮性肝损害的独立危险因素。

Objective To study the clinical features of liver involvement in systemic lupus erythematosus（SLE） for providing reliable clue for clinical diagnosis and differential diagnosis. Methods Retrospective analysis was performed in 566 cases of SLE in-patients. Lupus-associated hepatitis patients and SLE patients without liver disorder were compared in term of： general condition, laboratory findings and prognosis. The risk factors of lupus-associated hepatitis were analyzed. Suspected risk factors were selected by chi-square test and then were analyzed by logistic regression. Results There were 102 cases （18.02%） of lupus-associated hepatitis in 566 SLE patients.Lupus-associated hepatitis patients had higher IgG [（18.65±8.64） g/L vs （15.80±7.14） g/L, P〈0.01], higher erythrocyte sedimentation rate （ESR）[（22.85±9.30） mm/1h vs （19.89±9.70） mm/1h, P〈0.05], higher SLE disease activity index （SLEDAI） （13.3±8.4 vs 11.3±6.5, P〈0.05） and shorter course[（3.0±4.6） year vs （4.2±6.0）year, P〈0.05]. Seventy cases （68.6%） of lupus-associated hepatitis improved after 0.5-1 mg/kg methylprednisolone and glutathione treatment. Logistic regression analysis showed that the risk factors of lupus-associated hepatitis were cerebral involvement and age ≤ 18 years. Conclusions Liver involvement is not rare in SLE patients. If a SLE patient has high SLEDAI score, short course, high IgG and ESR with abnormal liver function, lupus-associated hepatitis should be considered. Most patients had a good prognosis after corticosteroids and glutathione therapy. The risk factors of lupus-associated hepatitis were cerebral involvement and age ≤ 18 years.