系统性红斑狼疮血液学异常与临床特点

Hematological Abnormality and Clinical Characteristics in Systemic Lupus Erythematosus

为了探讨系统性红斑狼疮 (SLE)血液学异常改变及其临床特点 ,对 5 8例SLE患者血液学资料及应用皮质激素和免疫抑制剂治疗的效果进行了回顾性分析。结果表明 :5 8例中血像异常者 5 0例 ( 86 .2 % ) ,以各系细胞减少为主 ,贫血 4 1例 ( 70 .7% ) ,血小板减少 34例 ( 5 8.7% ) ,白细胞减少 37例 ( 6 3.8% ) ,二系以上异常 4 1例( 70 7% ) ,以血液学异常为首发症状就诊者 12例 ( 2 0 .7% ) ,其中误诊为血液系统疾病 7例 ( 12 .1% )。在 5 8例中30例行骨髓细胞学检查 ,发现骨髓增生活跃或明显活跃 2 3例 ( 76 .7% ) ,增生低下者 7例 ( 2 3.3% ) ,患者表现为增生性贫血或特发性血小板减少性紫癜 (ITP)骨髓像。 38例行肝、脾B超检查 ,查明脾肿大 2 5例 ( 6 5 .8% ) ;2 5例行抗人球蛋白试验 ,3例阳性 ( 12 0 % ) ;2 2例血小板减少者行血小板抗体测定 ,16例抗体增高 ( 72 .7% ) ;给予 2 6例二系以上血细胞减少患者皮质激素和免疫抑制剂治疗 ,血像均有不同程度上升 ,其中包括 6例骨髓增生低下者。结论 :血液系统是SLE易并发损害的器官 ,相关血液学异常较常见 ,其特点是血液学改变多样性 ,缺乏特异性 ,以二系以上血细胞减少常见 ,在骨髓像方面主要表现为增生活跃。

To investigate the hematological abnormality and clinical characteristics in systemic lupus erythematosus (SLE), the hematological data of 58 SLE and the curative effects of corticosteroid and immunosuppressive agents on SLE were retrospectively analysed by using SPSS/PC software. The results showed that the incidence of hematological abnormalities in 58 cases was as follows: 50 cases of hemogram abnormality (86.2%), 41 of anemia (70.7%), 34 of thrombocytopenia (58.7%), 37 of leukopenia (63.8%). Peripheral cytopenia of every cell lineage was common in SLE. The cell abnormalities of two or three lineages were seen in 41 cases (70.7%). The initial symptoms with hematological abnormality were found in 12 cases (20.7%), 7 out of 12 cases were erroneously diagnosed as hematology diseases(12.1%). In 30 out of 58 patients, the results of bone marrow examination showed that 23 had hyperplasia (76.7%) and 7 were hypoplasia. In 25 out of 38 cases, splenomegaly (65.8%) was found by B ultrasonography. In 25 patients with SLE receiving Coombs test, 3 were positive(12.0%). PAIg increased in 16 out of 22 cases of thrombocytopenia (72.7%). 26 cases of SLE with two or three lineage cytopenia in peripheral blood were treated by corticosteroid and immunosuppressive agent. The hemogram improved in all patients including 6 cases of bone marrow hypoplasia. It is concluded that the hematological abnormalities are frequent in SLE patients, which are short of specialty. The cytopenia of two or more lineage in peripheral blood is most common when bone marrow shows hyperplastic. The therapy with corticosteroid and immunosuppressive agents is efficacious.