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目的探讨系统性红斑狼疮(SLE)患者血液系统异常的特点及其临床意义。方法236例新诊断的 SLE 住院患者,其巾血红蛋白≤100g/L 者设为贫血组;根据白细胞计数分为2组,白细胞计数<3.0×10~9/L 者为 WBC1组,白细胞计数3.0～3.9×10~9/L 为 WBC2组;血小板<100×10~9/L 设定为血小板减少组。无血液学异常者设定为对照组。结果贫血的患者123例,占52.1%。造成贫血的原因主要有:慢性病贫血(ACD),82例,溶血性贫血(HA),18例,造血功能异常8例,原因未明,15例。外周血有白细胞下降者73例,占30.9%。血小板下降57例,占24.2%。无血液学异常68例,占28.8%。其中溶血性贫血组、WBC1组和血小板减低组狼疮活动指标明显高于对照组。对72例患者做了骨髓细胞形态学检查,49例是正常骨髓象,10例患者骨髓有不同程度的病态造血,2例表现骨髓巨核细胞缺乏,9例表现为骨髓三系造血增生低下,有2例表现出单纯红系造血低下。结论中国 SLE 患者贫血比例较高的主要原因可能是慢性病贫血患者的比例明显高于国外。SLE 患者溶血性贫血比例较低,但却是 SLE 疾病活动很重要的指征。白细胞计数<3.0×10~9/L 和血小板下降也与SLE 活动有关。部分患者骨髓造血异常是引起较严重血液学改变的原因之一。
Objective To investigate the characteristics of blood system abnormalities in patients with systemic lupus erythematosus (SLE) and its clinical significance. Methods A total of 236 newly diagnosed SLE patients were enrolled as anemia group with hemoglobin ≤100g / L. According to leukocyte count, two groups were divided into two groups: WBC1 group with white blood cell count <3.0 × 10 ~ 9 / L, white blood cell count 3.0 ~ 3.9 × 10 ~ 9 / L for the WBC2 group; platelets <100 × 10 ~ 9 / L for the thrombocytopenia group. No hematological abnormalities were set as the control group. The results of anemia in 123 patients, accounting for 52.1%. The main causes of anemia are: chronic anemia (ACD), 82 cases, haemolytic anemia (HA), 18 cases, abnormal hematopoietic function in 8 cases, unexplained, 15 cases. 73 cases of leukopenia in peripheral blood, accounting for 30.9%. 57 cases of platelet decline, accounting for 24.2%. No hematological abnormalities in 68 cases, accounting for 28.8%. Including hemolytic anemia group, WBC1 group and thrombocytopenia group lupus activity index was significantly higher than the control group. Bone marrow cell morphometry was performed in 72 patients, 49 were normal bone marrow, 10 patients had varying degrees of morbid hematopoiesis in the bone marrow, 2 patients showed a lack of bone marrow megakaryocytes, 9 patients showed low bone marrow hyperplasia, 2 cases showed simple erythroid hematopoietic low. Conclusion The main reason for the high proportion of anemia in SLE patients in China may be that the proportion of anemia patients with chronic diseases is significantly higher than that of other countries. SLE patients with a lower proportion of hemolytic anemia, but it is SLE disease activity is very important indication. Leukocyte count <3.0 × 10 ~ 9 / L and thrombocytopenia also related to SLE activity. Some patients with abnormal bone marrow hematopoiesis is caused by one of the reasons.