CSTAR注册研究：初治系统性红斑狼疮相关血小板减少症的临床特点

Chinese SLE Treatment and Research Group Registry:Clinical Characteristics of Thrombocytopenia in Patients with Untreated Systemic Lupus Erythematosus

目的通过分析初治系统性红斑狼疮(systemic lupus erythematosus,SLE)患者相关血小板减少症的临床特点,提高对其的认识及诊治水平。方法本研究为基于中国系统性红斑狼疮研究协作组(Chinese SLE Treatment and Research group,CSTAR)所进行的横断面研究,分析2009年4月至2010年2月CSTAR项目在全国104家中心入组的904例初治SLE患者的血小板减少症与人口学资料、脏器受累、实验室检查及SLE疾病活动度的相关性。结果 904例初治SLE患者中,诊断血小板减少症者194例,占21.5%,这些患者中神经精神狼疮(10.3%)、血管炎(13.9%)、狼疮肾炎(58.8%)、白细胞减少症(34.5%)及低补体血症(87.1%)的发生率升高(P<0.05),而关节炎(30.4%)的发生率降低(P=0.001)。多因素分析显示白细胞减少症及SLE疾病活动指数(SLE disease activity index,SLEDAI)评分升高为血小板减少症的独立相关因素,P均<0.001,OR值分别为2.731及1.075。结论血小板减少症是SLE一个常见的临床表现,它的发生提示SLE病情处于活动期,并与其他系统受累具有相关性。SLE患者出现血小板减少症时应予以密切监测及积极治疗。

Objective To investigate the prevalence and clinical characteristics of thrombocytopenia in Chinese patients with untreated systemic lupus erythematosus （SLE）. Methods A prospective cross- sectional study of patients with untreated SLE was conducted based on the data from the Chinese SLE Treatment and Research group （CSTAR） registry. From April 2009 to February 2010, we recruited 904 untreated SLE patients from 104 centres across the country. The prevalence and associations of thrombocy- topenia with demographic data, organ involvements, laboratory findings, and SLE disease activity were investigated. Results Of 904 untreated patients with SLE, 194 patients （21.5%） were diagnosed with thrombocytopenia. The incidences of neuropsychiatric SLE （ 10. 3% ）, vasculitis （ 13.9%）, lupus nephri- tis （ 58.8% ）, leukocytopenia （ 34.5% ）, and hypocomplementemia （ 87.1% ） were significantly higher in patients with thrombocytopenia than those without （ P〈0. 05）, while arthritis （ 30. 4% ） showed a lower incidence in patients with thrombocytopenia （P = 0.001 ）. Multivariate analysis showed that leukocytopenia [ odds ratio （OR） = 2. 731 ] and elevated SLE disease activity index （SLEDAI） （OR 1. 075） were independent related factors of thrombocytopenia in patients with SLE （P〈0. 001 ）. Conclu- sion Thrombocytopenia is a common manifestation of SLE. The occurrence of thrombocytopenia indicates active SLE and other crucial system involvements. Patients with thrombocytopenia should be monitored closely and treated intensively.