系统性红斑狼疮皮疹的临床分析

目的探讨系统性红斑狼疮（SLE）皮疹的临床意义。 方法回顾性分析梅州市人民医院2010年1月至2016年12月诊治的661例确诊的SLE患者，根据皮肤有无皮疹损害分为皮疹组及非皮疹组，收集2组患者的临床表现、实验室结果和疾病活动等资料。采用χ²检验比较2组患者的各种临床表现的例数及实验室结果异常的例数，采用t检验比较2组患者血清补体C3、C4水平及SLE疾病活动指数评分，采用Logistic回归分析皮疹与性别、起病年龄、临床表现及实验室结果的相关性。 结果661例SLE患者中338例(51.1%)出现皮疹损害。皮疹组患者的发热、口腔溃疡、脱发、关节炎发生率均高于非皮疹组（38.5% vs 30.3%；27.8% vs 19.2%；39.3% vs 25.1%；63.0% vs 51.4%），差异有统计学意义［χ²=4.821，P=0.028；χ²=6.800，P=0.009；χ²=15.366，P<0.001；χ²=9.124，P=0.003］；皮疹组患者贫血的发生率低于非皮疹组（56.8% vs 64.4%），差异有统计学意义（χ²=3.984，P=0.046）。免疫学结果显示，皮疹组患者血清C3水平低于非皮疹组［（0.47±0.27）g/L vs （0.55±0.27）g/L］，差异具有统计学意义（χ²=-3.929，P<0.001）；皮疹组患者血清抗双联DNA抗体、抗Sm抗体的阳性率均高于非皮疹组（84.3% vs 77.7%；41.7% vs 27.9%），差异具有统计学意义（χ²=4.707，P=0.030；χ²=13.941，P<0.001）。Logistic回归分析结果显示，SLE患者发生皮疹的危险因素为口腔溃疡（OR=3.523，P<0.001）、脱发（OR=4.549，P<0.001）、关节炎（OR=1.758，P=0.002），起病年龄大（OR=0.502，P=0.006）、无贫血（OR=0.613，P=0.012）及补体C3水平正常（OR=0.472，P=0.006）是保护因素。 结论皮疹是SLE常见的临床表现之一，皮疹损害可能预示SLE疾病过程中更易发生多系统损害，SLE患者发生皮疹损害与起病年龄、临床表现及血清学异常密切相关。

Clinical analysis of rash in systemic lupus erythematosus

ObjectiveTo investigate the clinical significance of rash in patients with systemic lupus erythematosus (SLE). MethodsSix hundred and sixty-one SLE patients were enrolled into the study. The patients were divided into either a rash group or a control group (without rash manifestations) to compare the clinical findings, laboratory findings, and disease activity. The chi-square test was used to compare the number of clinical manifestations and the number of abnormal laboratory results in the two groups. The t-test was used to compare serum complement C3 and C4 levels and SLEDAI score between the two groups. Logistic regression was used to analyze the relation of rash with sex, onset age, clinical manifestations, and laboratory results. ResultsAmong the 661 SLE patients, 338 (51.1%) had rash manifestations. The incidence of fever (38.5%), oral ulcer (27.8%), hair loss (39.3%), and arthritis (63.0%) in the rash group was significantly higher than that in the control group (38.5% vs 30.3%, χ²=4.821, P=0.028; 27.8% vs 19.2%, χ²=6.800, P=0.009; 39.3% vs 25.1%, χ²=15.366, P<0.001; and 63.0% vs 51.4%, χ²=9.124, P=0.003, respectively). The incidence of anemia in the rash group was lower than that in the control group (56.8% vs 64.4%, χ²=3.984, P=0.046). Immunological findings showed that the level of complement C3 was lower in the rash group than in the control group (0.47±0.27) vs (0.55±0.27), χ²=-3.929, P<0.001]. SLE patients with rash had higher prevalence of anti-dsDNA antibody and anti-Sm antibody than those in the control group (84.3% vs 77.7%, χ²=4.707, P=0.030; and 41.7% vs 27.9%, χ²=13.941, P<0.001, respectively). The logistic regression analysis showed that oral ulcer (OR=3.523, P<0.001), hair loss (OR=4.549, P<0.001) and arthritis (OR=1.758, P=0.002) were risk factors for SLE rash, while older age (OR=0.502, P=0.006), no anemia (OR=0.613, P=0.012), and normal complement C3 level (OR=0.472, P=0.006) were protective factors. ConclusionRash is one of the most common clinical manifestations of SLE and may be a marker of more severe systemic disease over time in SLE patients. Rash in SLE patients is closely related to age of onset, clinical manifestations, and serological abnormalities.