系统性红斑狼疮并发蛋白丢失性肠病的危险因素

Risk Factors of Patients with Protein-losing Enteropathy in Systemic Lupus Erythematosus

目的对系统性红斑狼疮(systemic lupus erythematosus,SLE)并发蛋白丢失性肠病(protein-losing enteropathy,PLE)进行病例-对照研究,旨在总结本病的临床表现特点,探讨该并发症的危险因素。方法回顾性分析2000至2015年在北京协和医院住院的60例SLE并发PLE患者(PLE组)的临床资料,并与同期120例活动性SLE患者(对照组)进行比较。采用多因素Logistic回归分析方法,分析实验室各指标与并发PLE的关系,找出其危险因素。结果 PLE组患者平均血清白蛋白、补体C3、补体C4、血钙和24 h尿蛋白水平均显著低于对照组[(17.3±0.68)g/L vs.(32.3±0.80)g/L,P<0.001;(0.47±0.03)g/L vs.(0.62±0.03)g/L,P=0.001;(0.08±0.017)g/L vs.(0.09±0.018)g/L,P=0.622;(1.84±0.02)mmol/L vs.(2.08±0.02)mmol/L,P<0.001;(0.88±0.34)g/24 h vs.(2.76±0.36)g/24 h,P<0.001],而血胆固醇水平显著高于对照组[(7.36±0.36)mmol/L vs.(5.41±0.24)mmol/L,P<0.001]。PLE组患者血清抗SSA抗体(anti-SSA)和抗SSB抗体(anti-SSB)的阳性率高于对照组(61.7%vs.45.0%,P=0.035;23.3%vs.6.67%,P=0.001)。多因素Logistic回归分析显示,血清抗SSA抗体阳性、低白蛋白血症及高胆固醇血症是SLE并发PLE的独立危险因素(OR=3.520,P=0.024;OR=0.740,P<0.001;OR=0.815,P=0.041)。结论 SLE患者出现血清抗SSA抗体阳性、高胆固醇血症、严重低白蛋白血症时,应警惕SLE并发PLE的发生。

Objective To analyze clinical characteristics, laboratory findings, and risk factors of the protein-losing enteropathy （PLE） in systemic lupus erythematosus （SLE）. Methods A retrospective, case-control study was performed in 60 patients with SLE-related PLE （PLE group） and 120 patients with active SLE （control group） admitted to our center from January 2000 to December 2015. Variables with significant P values between groups in the univariate analysis were further analyzed by a multivariate Logistic regression model to predict independent risk factors for SLE-related PLE. Results The PLE group had lower mean serum albumin and 24-hour urine protein levels, higher mean total plasma cholesterol levels, and greater frequencies of anti-SSA and SSB positivity compared with the control group. Anti-SSA seropositivity, hypoalbuminemia, and hypercholesterolemia were independent risk factors for SLE-related PLE. Conclusion SLE-related PLE should be considered when an SLE patient presents with anti-SSA antibody seropositivity, hypercholesterolemia, and severe hypoalbuminemia.