中华皮肤科杂志 ›› 2017, Vol. 50 ›› Issue (6): 439-442.

• 研究报道 • 上一篇    下一篇

系统性红斑狼疮患者皮肤血管炎的临床研究

陈圣安1,杨凡萍2,薛海玉3,骆肖群4   

  1. 1. 复旦大学附属华山医院
    2. 复旦大学附属华山医院皮肤科
    3.
    4. 上海复旦大学附属华山医院皮肤科
  • 收稿日期:2016-06-20 修回日期:2017-01-15 发布日期:2017-05-31
  • 通讯作者: 骆肖群 E-mail:shanghaixiaolai@163.com

Clinical characteristics of systemic lupus erythematosus patients with cutaneous vasculitis

  • Received:2016-06-20 Revised:2017-01-15 Published:2017-05-31
  • Contact: LUO Xiao-qun E-mail:shanghaixiaolai@163.com

摘要: 目的 比较有无皮肤血管炎表现的系统性红斑狼疮(SLE)患者的临床和实验室特点,探讨SLE患者皮肤血管炎与实验室指标以及内脏损伤的关系。方法 分析2011年7月至2014年10月复旦大学附属华山医院皮肤科收治的152例有皮肤症状的SLE患者临床和实验室资料,并将其分为四肢末端血管炎组和网状青斑组。应用logistic回归模型分析皮肤血管炎与临床和实验室各变量的关系。结果 152例SLE患者中,62例(41%)有皮肤血管炎表现(包括55例四肢末端血管炎和7例网状青斑),90例(59%)无皮肤血管炎。四肢末端血管炎组患者年龄(30.54 ± 12.67)岁、24 h尿蛋白定量和血清尿素异常升高分别为39.39%和2.08%,均明显低于无血管炎组年龄(37.77 ± 12.17)岁,64.00%和16.43%,而女性比例(98.18%)、头颅MRI异常(37.50%)、贫血(87.03%)、抗核糖体P蛋白抗体阳性的比例(77.77%)及SLEDAI指数(14.71 ± 7.75)均明显高于无血管炎组(84.44%、12.19%、70.93%、53.65%、10.68 ± 5.61),差异有统计学意义(均P < 0.05),而C3降低的比例与无血管炎组相比差异无统计学意义(P = 0.362)。网状青斑组患者C3降低的比例(28.57%)显著低于无血管炎组(79.76%,P = 0.008),其他指标与无血管炎组相比,差异无统计学意义(均P > 0.05)。体质指数(BMI)、肺功能异常及其他实验室指标在四肢末端血管炎组、网状青斑组及无血管炎组间差异无统计学意义(均P > 0.05)。logistic回归分析显示,在排除了年龄和性别的影响后,皮肤血管炎与头颅MRI异常(OR = 4.24,95% CI:1.17 ~ 16.13,P = 0.028)及抗核糖体P蛋白抗体阳性(OR = 3.97,95% CI:1.86 ~ 8.47,P = 0.0004)呈显著正影响的关系;与24 h尿蛋白异常呈显著负影响的关系(OR = 0.25,95% CI:0.09 ~ 0.69,P = 0.009);与血清尿素异常(OR = 0.12,95% CI:0.01 ~ 1.06)、C3降低(OR = 0.93,95% CI:0.38 ~ 2.28)、贫血(OR = 1.38,95% CI:0.56 ~ 3.40)及SLEDAI(OR = 1.05,95% CI:0.98 ~ 1.14)则无显著影响关系(均P > 0.05)。结论 皮肤血管炎与SLE中枢神经系统损伤及抗核糖体P蛋白抗体的产生密切相关,对具有此类皮肤损伤的SLE患者,应密切监测中枢神经系统损伤情况。无皮肤血管炎的SLE患者发生肾脏损伤的概率较大,也需加强监测。

Abstract: Chen Sheng′an, Yang Fanping, Xue Haiyu, Luo Xiaoqun Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China Corresponding author: Luo Xiaoqun, Email: luoxiaoqun913@163.com 【Abstract】 Objective To compare clinical and laboratory characteristics between systemic lupus erythematosus (SLE) patients with and without cutaneous vasculitis, and to investigate the correlation of cutaneous vasculitis with severe visceral involvement and laboratory biomarkers. Methods A total of 152 SLE patients with various skin manifestations were enrolled from Department of Dermatology of Huashan Hospital affiliated to Fudan University from July 2011 to October 2014. The clinical and laboratory data were collected and retrospectively analyzed. SLE patients with cutaneous vasculitis were divided into upper/lower extremity vasculitis group and livedo reticularis group. A logistic regression model was used to analyze the correlation between cutaneous vasculitis and various clinical and laboratory variables. Results Of 152 SLE patients, 62 (41%) presented with cutaneous vasculitis, including 55 with upper/lower extremity vasculitis and 7 with livedo reticularis, and 90 (59%) did not have cutaneous vasculitis. Patients with upper/lower extremity vasculitis showed significantly younger age (30.54 ± 12.67 years vs. 37.77 ± 12.17 years), and lower prevalence of aberrantly elevated 24?hour protein excretion (39.39% vs. 64.00%) and serum urea level (2.08% vs. 16.43%), but significantly higher percentage of females (98.18% vs. 84.44%), higher proportions of patients with abnormal brain MRI (37.5% vs. 12.19% ), anemia (87.03% vs. 70.93%) and positive anti?ribosomal P protein antibodies (77.77% vs. 53.65%), and higher SLE disease activity index (SLEDAI) (14.71 ± 7.75 vs. 10.68 ± 5.61) than those without vasculitis (all P < 0.05 ). The proportion of patients with decreased C3 level did not differ between patients with upper/lower extremity vasculitis and those without cutaneous vasculitis (P = 0.362), but was significantly lower in the patients with livedo reticularis than in those without cutaneous vasculitis (28.57% vs. 79.76%, P = 0.008). However, no significant differences in the other variables were observed between patients with livedo reticularis and those without cutaneous vasculitis (all P > 0.05). Additionally, body mass index (BMI), abnormal lung function and other laboratory variables all did not differ among patients with upper/lower extremity vasculitis, patients with livedo reticularis and patients without cutaneous vasculitis (all P > 0.05). Logistic regression analysis revealed that after exclusion of potential effects of age and gender, cutaneous vasculitis was significantly positively correlated with abnormal brain MRI (OR = 4.24, 95% CI: 1.17 - 16.13, P = 0.028), and positive anti?ribosomal P protein antibodies (OR = 3.97, 95% CI: 1.86 - 8.47, P = 0.0004), but negatively correlated with abnormally elevated 24?hour protein excretion (OR = 0.25, 95% CI: 0.09 - 0.69, P = 0.009). Furthermore, cutaneous vasculitis showed no significant associations with abnormal serum urea level (OR = 0.12, 95% CI: 0.01 - 1.06), decreased C3 level (OR = 0.93, 95% CI: 0.38 - 2.28), anemia (OR = 1.38, 95% CI: 0.56 - 3.40) or SLEDAI (OR = 1.05, 95% CI: 0.98 - 1.14). Conclusions Cutaneous vasculitis is closely associated with central nervous system damage and emergence of anti?ribosomal P protein antibodies, so SLE patients with cutaneous vasculitis should be closely monitored for central nervous system damage. SLE patients without cutaneous vasculitis are more liable to kidney injury, so they also need to be closely monitored.

中图分类号: 

  • R593.24+1

引用本文

陈圣安 杨凡萍 薛海玉 骆肖群. 系统性红斑狼疮患者皮肤血管炎的临床研究[J]. 中华皮肤科杂志, 2017,50(6):439-442. doi: