系统性红斑狼疮并发间质性肺病危险因素及中医证型相关性分析

Analysis of Correlation between Risk Factors and Traditional Chinese Medicine Syndromes of Systemic Lupus Erythematosus Complicated with Interstitial Lung Disease

【目的】探究系统性红斑狼疮(SLE)并发间质性肺病(ILD)的危险因素及相关实验指标与中医证型相关性,为其疾病防治提供参考。【方法】回顾性收集并分析2014年1月~2021年10月在广州中医药大学第一附属医院住院的45例SLE-ILD患者和47例SLE患者的临床资料,并分别设置为SLE-ILD组和SLE组。采用Logistic回归分析探究SLE并发ILD的危险因素,单因素方差分析探究抗ENA抗体谱、体液免疫功能、C反应蛋白(CRP)、循环免疫复合物(CIC)等相关实验室指标与中医证型的关系。【结果】(1)2组患者在性别、免疫球蛋白(Ig)A、IgM、IgE、抗SSA抗体、抗ANA抗体、抗Sm抗体、抗J0-1抗体、抗scl70抗体、抗nRNP抗体、抗CenpB抗体、抗AnuA抗体、抗AHA抗体等方面的比较,差异均无统计学意义(P>0.05);而在年龄、补体C3、补体C4、IgG、CIC、CRP、抗SSB抗体、抗rRNP抗体、抗Ro52抗体、同时合并狼疮肾等方面的比较,差异均有统计学意义(P<0.05或P<0.01)。(2)Logistic回归分析显示,年龄(OR=1.104,95%CI=1.048~1.162,P=0.000)、IgG(OR=1.166,95%CI=1.049~1.295,P=0.004)为独立危险因素。(3)与阴虚内热及脾肾阳虚患者比较,热毒炽盛患者高分辨率计算机断层扫描(HRCT)评分(Warrick评分)最高而FVC%、FEV1%最低,且热毒炽盛患者IgG水平明显高于阴虚内热及脾肾阳虚患者,差异均有统计学意义(P<0.05或P<0.01)。【结论】IgG、年龄是SLE并发ILD的独立危险因素;热毒炽盛证是ILD严重程度最高的证型;IgG水平随着证型的转变而波动,可为中医辨证分型提供参考。

Objective To explore the correlation of the risk factors and laboratory indexes with traditional Chinese medicine(TCM)syndrome types in the patients with systemic lupus erythematosus(SLE)complicated with interstitial lung disease(ILD),and to provide reference for the prevention and treatment of SLE-ILD.Methods The clinical data of 45 patients with SLE-ILD and 47 patients with SLE who were hospitalized in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2014 to October 2021 were collected.The patients were allocated to SLE-ILD group and SLE group,respectively.Logistic regression analysis was used to investigate the risk factors for SLE complicated with ILD,and one-way ANOVA was used to explore the correlation between TCM syndrome types and relevant laboratory indicators associated with anti-ENA antibody profile,humoral immune function,C-reactive protein(CRP),and circulating immune complex(CIC).Results(1)There were no statistically significant differences between the two groups in terms of gender,immunoglobulin(Ig)A,IgM,IgE,anti-SSA antibody,anti-ANA antibody,anti-Sm antibody,anti-J0-1 antibody,antiscl70 antibody,anti-nRNP antibody,anti-CenpB antibody,anti-AnuA antibody,and anti-AHA antibody(P>0.05);while there were statistically significant differences in terms of age,complement 3(C3),complement 4(C4),IgG,CIC,CRP,anti-SSB antibody,anti-rRNP antibody,anti-Ro52 antibody,and comorbidity of lupus nephritis(P<0.05 or P<0.01).(2)The results of logistic regression analysis showed that age(OR=1.104,95%CI being 1.048-1.162,P=0.000)and IgG(OR=1.166,95%CI being 1.049-1.295,P=0.004)were the independent risk factors.(3)Compared to the patients with yin deficiency and internal heat syndrome and the patients with spleen and kidney yang deficiency syndrome,patients with abundant heat toxin syndrome had high Warrick scores evaluated with high-resolution computed tomography(HRCT),low percentage of forced vital capacity to the predicted value(FVC%)and percentage of the forced expiratory volume in one second to the predicted value(FEV1%),and high IgG level,and the differences were statistically significant(P<0.05 or P<0.01).Conclusion IgG level and age are the independent risk factors for SLE complicated with ILD,abundant heat toxin syndrome is the most severe syndrome type of ILD,and IgG level fluctuates with the evolution of syndrome types.The results will provide a reference for TCM syndrome differentiation and classification of SLEILD.