系统性红斑狼疮合并静脉血栓栓塞症临床相关危险因素分析

Clinical relative risk factors of venous thromboembolism in systemic lupus erythematosus patients

摘要:

目的 探讨系统性红斑狼疮（SLE）合并发生静脉血栓栓塞症（VTE）的临床相关危险因素。方法 回顾性连续收集2008年1月至2012年2月期间在解放军总医院住院治疗的27例SLE并发VTE的患者入血栓组，并募集同期27例与血栓组性别、年龄、体质量指数（BMI）、生活方式等环境因素相匹配的不伴有VTE的SLE患者作为对照组，利用单因素统计学分析两组患者的静脉血栓形成相关临床危险因素（血小板计数、免疫功能、补体、合并低蛋白血症、狼疮肾炎、肾功能不全、肾病综合征、肾性高血压、蛋白尿、血尿等）及实验室诊断指标[C-反应蛋白（CRP）、D-二聚体，白细胞计数、活化部分凝血活酶时间（APTT）、血浆凝血酶原时间（PT）、血浆纤维蛋白原（FIB）]的差异。结果 与对照组相比，血栓组合并低蛋白血症（70.37%）、狼疮肾炎（74.07%）、肾功能不全（70.37%）、肾病综合征（55.56%）、肾性高血压（66.67%）的发生率均显著升高（P值分别为0.003，0.000，0.000，0.027，0.029）。血栓组患者的实验室检测指标CRP（7.19±9.23）mg/L和D-二聚体（6.32±5.75）mg/L均显著高于对照组（P值分别为0.004，0.000）。结论 低蛋白血症、狼疮肾炎、肾功能不全、肾病综合征及肾性高血压可能是SLE合并VTE的临床相关危险因素；CRP及D-二聚体可能成为SLE合并VTE的实验室诊断指标。

Abstract:

Objective To investigate the clinical relative risk factors of venous thromboembolism (VTE) in systemic lupus erythematosus (SLE) patients. Methods Twenty-seven consecutive SLE patients with VTE in our hospital within January 2008 to February 2012 were enrolled as the thrombosis group, while the control group recruited 27 hospitalized SLE patients without history of thrombosis, whose environmental factors, such as sex, age, body mass index (BMI), and life style, matched to the thrombosis group. Univariate analysis was used to compare the clinical risk factors of venous thrombosis [blood platelet count, immunological function, complement, and whether accompanied with hypoproteinemia, lupus nephritis, renal insufficiency, nephrotic syndrome, renal hypertension, proteinuria, or hematuria], and laboratory indexes [C-reactive protein (CRP), D-dimer, white blood cell count, activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen (FIB)] between the two groups. Results The thrombosis group had significant higher incidence of accompanied hypoproteinemia (70.37%), lupus nephritis (74.07%), renal insufficiency (70.37%), nephrotic syndrome (55.56%), renal hypertension (66.67%) than the control group (P＝0.003, 0.000, 0.000, 0.027, 0.029, respectively). CRP [(7.19±9.23)mg/L] and D-dimer [(6.32±5.75)mg/L] levels were both higher in the thrombosis group than in the control group (P＝0.004, 0.000, respectively). Conclusion Hypoproteinemia, lupus nephritis, renal insufficiency nephrotic syndrome and renal hypertension may be the clinical risk factors of VTE in SLE patients. CRP and D-dimer may contribute to the diagnosis.