摘要
目的抗心磷脂抗体(aCL)是抗磷脂抗体综合征的标志抗体,20%~40%系统性红斑狼疮(SLE)患者aPL阳性。文中探讨aCL阳性SLE患者临床特点和预后。方法收集1999年1月至2009年12月在南京鼓楼医院等江苏省内26家医院首次住院,检测aCL的SLE患者495例,按照检测结果分为aCL阳性组和aCL阴性组。随访患者生存状态,比较患者人口学特征、受累器官、实验室检查、治疗药物和预后的差异。结果本组SLE患者中146例为aCL阳性。aCL阳性组女性所占比例(96.6%)显著高于aCL阴性组(90.8%),差异具有统计学意义(P<0.05)。aCL阳性组贫血发生率(74.7%vs61.3%)、C3降低率(81.5%vs71.1%)、抗核抗体阳性率(97.2%vs92.4%)及抗dsDNA抗体阳性比例(61.9%vs49.6%)均显著高于aCL阴性组,差异有统计学意义(P<0.05)。aCL阳性组接受环磷酰胺免疫抑制治疗比例较高(39.5%vs50.7%,P<0.05)。随访结束aCL阳性组病死率为13.7%,阴性组病死率为14.9%,差异无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,aCL阳性组1年、5年、10年生存率分别为94.5%、89.0%、82.9%;与aCL阴性组相比,差异无统计学意义(P=0.776)。aCL阳性组主要死亡原因依次为狼疮脑病(6例,30.0%)、肾衰竭(5例,25.0%)、心脏衰竭(4例,20.0%)和感染(3例,15%);aCL阴性组主要死亡原因依次为感染(21例,40.4%)、狼疮脑病(11例,21.2%)和心脏衰竭(5例,9.6%)和肾衰竭(4例,7.7%)。结论SLE患者合并aCL阳性者易出现贫血、C3降低、抗核抗体阳性、抗dsDNA抗体阳性。aCL阳性患者更多接受环磷酰胺治疗,长期随访aCL阳性对患者预后生存情况无影响。
Objectives Anticardiolipin antibody(aCL)is an important component of antiphospholipid antibody(aPL)and a marker antibody of antiphospholipid syndrome(aPS). APL is positive in 20% to 40% of patients with systemic lupus erythematosus(SLE). This article investigated the clinical features and prognosis of SLE patients with aCL. Methods From January 1999 to December 2009,495 cases of SLE patients detected aCL who were hospitalized for the first time in 26 hospitals in Jiangsu Province including Nanjing Drum Tower Hospital were divided into aCL-positive group and aCL-negative group according to the test results. The patients were followed up in survival status,and the demographic characteristics,affected organs,laboratory tests,treatment drugs,and prognosis were compared between two groups. Results 146 of the SLE patients in this group were positive for aCL. The proportion of women in aCL- positive group(96.6%)was significantly higher than that in aCL-negative group(90.8%),and the difference was statistically significant(P<0.05). The proportion of anemia(74.7% vs 61.3%),decreased C3(81.5% vs 71.1%),positive antinuclear antibody(97.2% vs 92.4%),and positive anti-dsDNA antibody (61.9% vs 49.6%)in aCL-positive group were significantly higher than those of aCL-negative group,and the difference was statistically significant(P<0.05). The aCL-positive group received a higher proportion of cyclophosphamide immunosuppressive therapy(39.5% vs 50.7%,P<0.05). At the end of follow-up,the mortality rate of aCL-positive group was 13.7%,and the mortality rate of aCL-negative group was 14.9% and there was no significant difference in mortality(P>0.05). Kaplan-Meier survival analysis showed that the 1- year,5-year,and 10-year survival rates of aCL-positive group were 94.5%,89.0%,and 82.9%,respectively,and there was no significant difference compared with aCL-negative group(P=0.776). The main causes of death in aCL-positive group were lupus encephalopathy(6 cases,30.0%),renal failure(5 cases,25.0%),heart failure(4 cases,20.0%)and infection(3 cases,15%). The main causes of death in aCL-negative group were infection(21 cases,40.4%),lupus encephalopathy(11 cases,21.2%)and heart failure (5 cases,9.6%)and renal failure(4 cases,7.7%). Conclusion SLE patients with aCL represent a high propotion in anemia,decreased C3,positive antinuclear antibody,positive anti-dsDNA antibody. There was no significant difference in disease activity and significant organ involvement between two groups. More SLE patients with aCL were treated with cyclophosphamide,and there was no significant difference in survival status between SLE patients with and without aCL during long-term follow-up.
作者
张莹
温利辉
王美美
张缪佳
钱先
刘琳
魏华
冯学兵
孙凌云
ZHANG Ying;WEN Li-hui;WANG Mei-mei;ZHANG Miao-jia;QIAN Xian;LIU Lin;WEI Hua;FENG Xue-bing;SUN Ling-yun(Department of Rheumatology and Immunology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Department of Rheumatology,Southeast University Zhongda Hospital,Nanjing 210009,Jiangsu,China;Department of Rheumatology,Jiangsu Province Hospital,Nanjing 210029,Jiangsu,China;Department of Rheumatology,Jiangsu Province Hospital of TCM,Nanjing 210029,Jiangsu,China;Department of Rheumatology,Xuzhou Central Hospital,Xuzhou 221009,Jiangsu,China;Department of Rheumatology,Northern Jiangsu People's Hospital,Yangzhou 225001,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2019年第9期958-962,共5页
Journal of Medical Postgraduates
基金
江苏省自然科学基金(BK20180121)
关键词
系统性红斑狼疮
抗心磷脂抗体
临床特点
预后
systemic lupus erythematosus
anti-cardiolipin antibodies
clinical manifestations
prognosis
作者简介
张莹,南京大学医学院附属鼓楼医院风湿免疫科医学博士;通信作者:冯学兵,E-mail:fengxuebing@hotmail.com.
