系统性红斑狼疮患者并发中重度血小板减少症的疗效观察及相关因素分析

The curative effect in patients with systemic lupus erythematosus complicated by moderate or severe thrombocytopenia

目的:观察系统性红斑狼疮(SLE)并发中重度血小板减少症[血小板计数(BPC)<50×109/L]患者的疗效,并探讨其相关因素。方法:回顾性分析109例SLE并发中重度血小板减少症住院患者的临床特征及治疗措施。结果:109例患者中完全缓解(CR)82例(75.2%),部分缓解(PR)15例(13.8%),无效(NR)12例(11.0%)。与有效组(CR+PR)比较,无效组(NR)骨髓巨核细胞减少的发生率较高(P<0.05);两组间疾病活动度指数(SLEDAI)评分,血小板相关抗体(PAIg)阳性、抗心磷脂抗体(ACA)阳性的发生率和补体(C)3、C4的水平差异均无统计学意义。甲泼尼龙(MP)冲击治疗组和大剂量激素治疗组总有效率比较,差异亦无统计学意义。结论:骨髓巨核细胞减少可能为影响SLE并发中重度血小板减少症患者疗效的不良因素。

Objective To observe the curative effect in patients with systemic lupus erythematosus （SLE） complicated by moderate or severe thrombocytopenia with a blood platelet count （ BPC ） of under 50 × 10^9/L and analyze its related factors. Methods We retrospectively analyzed the clinical data on 109 SLE patients with moderate or severe thrombocytopenia. Results Of the 109 patients, 82 （75.2%）had complete response （CR） , 15 （13.8%） had partial response （PR）, and 12 （11.0% ） had no response （NR）, respectively. As compared with the CR＋PR group, the NR group had a higher incidence rate of decreased bone marrow megakaryocyte （P 〈 0.05）. However, there were no significant differences between the two groups in SLEDAI scores, rates of positive PAIg and ACA, and levels of C3 and C4 （P 〉 0.05 for all comparisons）. The total effectiveness rate did not differ significantly between MP pulse therapy and high-dose eorticosteroid therapy. Conclusions A decrease in bone marrow megakaryocytes can be an adverse factorfor affecting the efficacy in patients with SLE complicated by moderate or severe thromboeytopenia.