系统性红斑狼疮合并肺血栓栓塞症的临床特点及相关因素分析

Analysis of Clinical Characteristics and Related Risk Factors of Systemic Lupus Erythematosus Complicated with Pulmonary Thromboembolism

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并肺血栓栓塞症(pulmonary thromboembolism,PTE)患者的临床特点及相关危险因素。方法收集宁夏医科大学总医院2009年1月至2021年12月就诊的合并PTE的SLE患者47例作为病例组(SLE-PTE组),等距抽取年龄、性别和入院时间匹配的未合并PTE的SLE患者207例作为对照组(SLE-non-PTE组),比较两组的临床特点及实验室检查资料。结果与SLE-non-PTE组相比,SLE-PTE组患者呼吸困难、胸痛、咯血、下肢肿胀、下肢疼痛的阳性率较高,SLEDAI、NEUT、APTT、D-D、CHOL、ESR、CRP、aCL和抗Sm抗体水平较高,ALB、PLT水平较低,胸腔积液、肺动脉高压、肺动脉增宽、心包积液的发生比例较高,感染、肺部感染、脑梗死和继发性抗磷脂综合征的比例较高(P均<0.05)。Logistic回归分析显示,SLEDAI、CRP、D-D和CHOL与SLE-PTE的发生有统计学关联(P均<0.05)。ROC曲线分析显示SLEDAI、CRP、D-D、CHOL和PLT联合诊断的曲线下面积(AUC)最大,联合诊断的敏感度为76.20%,特异度为81.00%(P均<0.05)。结论PTE易发生于活动性SLE患者,CRP、D-D、CHOL、SLEDAI与SLE-PTE的发生相关,CRP、D-D、CHOL、PLT、SLEDAI联合诊断可提高SLE-PTE诊断效能。

Objective To study the clinical characteristics and related factors in patients with systemic lupus erythematosus complicated with pulmonary thromboembolism(SLE-PTE).Methods From January 2009 to December 2021,47 SLE patients with PTE in the General Hospital of Ningxia Medical University were collected as the case group(SLE-PTE group),and 207 SLE patients without PTE matching age,sex and admission time were equidistant selected as the control group(SLE-non-PTE group).The clinical characteristics and laboratory examination data of the two groups were compared.Results Compared with SLE-non-PTE group,the positive rates of dyspnea,chest pain,hemoptysis,lower limb swelling and pain in SLE-PTE group were higher,SLEDAI,NEUT,APTT,D-D,CHOL,ESR,CRP,aCL and anti-Sm antibody were higher,and ALB and PLT levels were lower.The proportion of pleural effusion,pulmonary hypertension,pulmonary artery widening and pericardial effusion were higher,and the proportion of infection,pulmonary infection,cerebral infarction and secondary APS were higher(P all<0.05).Logistic regression analysis showed that SLEDAI,CRP,D-D and CHOL are statistically associated with the occurrence of SLE-PTE patients(P all<0.05).ROC curve analysis showed that the combination of SLEDAI,CRP,D-D,CHOL and PLT had the largest area under the curve(AUC)and the highest diagnostic efficiency.The sensitivity of the combined diagnosis was 76.20%and the specificity was 81.00%(P all<0.05).Conclusion PTE was prone to occur in patients with active SLE.CRP,D-D,CHOL,and SLEDAI were associated with the development of SLE-PTE.The diagnostic efficiency of SLE-PTE can be improved by the combination of CRP,D-D,CHOL,PLT,and SLEDAI.