血清IgG水平正常初诊系统性红斑狼疮患者的临床评估

Clinical evaluation of newly diagnosed systemic lupus erythematosus patients with normal serum IgG levels

目的探讨血清免疫球蛋白G(immunoglobulin G,IgG)水平正常初诊系统性红斑狼疮(systemic lupus erythematosus,SLE)患者的临床特点,以期提高临床对血清IgG水平正常SLE患者的认识。方法回顾性分析本院风湿免疫科321例初诊SLE患者的临床资料,比较血清IgG水平正常组和血清IgG水平升高组患者一般资料、临床表现、实验室指标、狼疮疾病活动度、治疗及生存率差异。结果血清IgG水平正常组患者确诊时病程较血清IgG水平升高组长(P<0.05),蛋白尿发生率高于血清IgG水平升高组(P<0.05),其他系统损害如自身免疫性溶血性贫血、肝功能损害、继发干燥综合征、抗磷脂综合征的发生率低于血清IgG水平升高组(P<0.05),浆膜炎、间质性肺炎、神经精神狼疮等发生率和SLEDAI评分两组患者差异无统计学意义(P>0.05)。血清IgG水平正常组患者血清IgG、IgA、IgM、类风湿因子、外周血CD4^(+)/CD8^(+)比值低于血清IgG水平升高组(P<0.05),血清补体C4、外周血CD3^(+)T淋巴细胞绝对值、外周血CD8^(+)T淋巴细胞绝对值高于血清IgG水平升高组(P<0.05),血沉、超敏-C反应蛋白、补体C3、IL-6等两组差异无统计学意义(P>0.05)。血清IgG水平正常组患者抗SSA抗体、抗Ro-52抗体、抗nRNP/Sm抗体、抗Sm抗体、抗心磷脂抗体、直接抗人球蛋白试验阳性率低于血清IgG水平升高组(P<0.05),抗dsDNA抗体、抗核小体抗体、抗组蛋白抗体、抗β2糖蛋白1抗体等两组差异无统计学意义(P>0.05)。两组患者治疗及生存曲线比较差异无统计学意义(P>0.05)。结论血清IgG水平正常初诊SLE患者仍可呈现多系统损害、中重度活动性狼疮、免疫功能紊乱,临床应提高对血清IgG水平正常SLE患者的重视。

Objective To explore the clinical characteristics of newly diagnosed systemic lupus erythematosus(SLE)patients with normal serum immunoglobulin G(IgG),so as to improve the clinical understanding of patients with normal serum IgG levels.Methods The clinical data of 321 newly diagnosed SLE patients in the Department of Rheumatology,Tongji Hospital was retrospectively analyzed,and the differences of demographic characteristics,clinical manifestations,laboratory indicators,disease activities of SLE patients,treatment,and outcome in normal serum IgG levels group and elevated serum IgG group were compared.Results The course of disease was longer in normal serum IgG levels group than in elevated serum IgG group(P<0.05).The incidence of proteinuria was higher than that of elevated serum IgG group(P<0.05).The incidences of other systemic damages such as autoimmune hemolytic anemia,liver function damage,secondary Sjogren’s syndrome,and antiphospholipid syndrome were lower than those of serum IgG elevation group(P<0.05).However,there were no significant differences in the incidences of serositis,interstitial pneumonia,neuropsychiatric lupus,and SLEDAI scores between the two groups(P>0.05).The serum IgG,IgA,IgM,rheumatoid factors(RF),and peripheral blood CD4^(+)/CD8^(+)ratio in normal serum IgG levels group were lower than those in serum IgG elevation group(P<0.05),the absolute values of serum complement C4,peripheral blood CD3^(+)T lymphocyte,and peripheral blood CD8^(+)T lymphocyte were higher than those in serum IgG elevation group(P<0.05),erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),complement C3,and IL-6 were not significantly different between the two groups(P>0.05).The positive rates of anti-SSA antibody,anti-Ro52 antibody,anti-nRNP/Sm antibody,anti-Sm antibody,anti-cardiolipin antibody and direct anti-human globulin in normal serum IgG levels group were lower than those in elevated serum IgG group(P<0.05).Anti-dsDNA antibody,anti-nucleosome antibody,anti-histone antibody,and anti-β2 glycoprotein 1 antibody had no statistical difference between the two groups(P>0.05).There were no significant differences in treatment and survival curve between the two groups.Conclusions Newly diagnosed SLE patients with normal serum IgG levels can still present with multi-system damage,moderate and severe active lupus,and immune dysfunction.Clinical attention should be paid to SLE patients with normal serum IgG levels.