Clinical Features And Risk Factors Analysis Of Protein-losing Gastroenteropathy

Research BackgroundProtein-losing gastroenteropathy(PLG)refers to a syndrome in which protein lost into the gastrointestinal tract due to intestinal or extraintestinal diseases.PLG is associated with a variety of different diseases,such as systemic lupus erythematosus(SLE),Crohn’s disease,small intestinal lymphangiectasia,Whipple’s disease,and tuberculous peritonitis.The main clinical features of PLG are hypoproteinemia and edema,as well as digestive system manifestations such as abdominal pain,diarrhea,anorexia,and bloody stool.The main point of treatment lies in the discovery and treatment of primary disease.In addition,diet therapy and supportive therapy also play important roles.Specific diagnostic methods for PLG include the detections of fecal α1-antitrypsin concentration,24-hour fecal α1-antitrypsin clearance,and 99mTc-labeled albumin scintigraphy(99mTc-HAS).99mTc-HAS is an important method for diagnosing PLG.With the improvement of imaging technology and disease awareness,the incidence of PLG has increased year by year.This puts forward higher requirements for the diagnosis and treatment of PLG.Studies have shown that there is a large difference in the distribution of PLG primary diseases between Western countries and East Asia.Congenital heart disease is the main disease in the West and systemic lupus erythematosus is more common in China.There are still few papers on PLG at home and abroad,most of them are single case reports.A single-center retrospective study was conducted in this study to analyze the clinical data of 33 PLG patients treated at the First Affiliated Hospital of Zhengzhou University from October 2010 to October 2019.ObjectiveThis study aims to investigate the clinical characteristics of PLG patients and the risk factors of lupus-related PLG,and to provide a reference for clinical diagnosis of PLG and to determine the primary disease.Methods(1)Retrospective analysis of the clinical data of 33 PLG patients at the First Affiliated Hospital of Zhengzhou University from October 2010 to October 2019.The clinical characteristics include gender,age,admission method,admission date,admission diagnosis,personal history,past medical history,symptoms,complications,laboratory parameters at admission,imaging data,treatment method and hospital stays.(2)Analysis of clinical characteristics based on whether the primary disease is SLE.With P<0.10 as the inclusion variable criterion,globulin and white blood cells were selected for binary multivariate logistic regression analysis and ROC curves were drawn.(3)For SLE-related PLG patient,a control group was selected from SLE patients without PLG in the same period at a ratio of 1:10.The clinical and laboratory characteristics of the two groups were analyzed.Using P<0.10 as the inclusion variable criterion,hospital stays,edema,joint pain,albumin,triglyceride,D-dimer,complement C3,complement C4,and serum calcium were selected for binary multivariate logistic regression analysis and ROC curves were drawn.(4)Statistical analysis was performed using SSPS 19.0.Measurement data are expressed as mean and standard deviation or median and quartile.Comparison of measurement data used t test,adjusted t test,Mann-Whitney U test.Fisher exact test was used to compare constituent ratio differences.Logistic multivariate regression analysis was used to screen for possible risk factors.P<0.05 was defined as a statistically significant difference.Results1、This study included 33 patients with PLG who were admitted to the First Affiliated Hospital of Zhengzhou University from October 2010 to October 2019,8 of whom have SLE as their primary disease.The main manifestations are edema(54.55%),serous fluid(75.76%),and hypoalbuminemia(100%).The main treatment method is to cure the primary disease.2、Lupus-related PLG is statistically different from PLG with other primary diseases in globulin,total protein,and white blood cells(P<0.05).Through Logistic regression analysis,high globulin level is an independent risk factor.By ROC curve analysis,the critical value of globulin is 28.65g/L,the corresponding sensitivity is 0.750,and the specificity is 0.880.3、There is a statistically significant difference in hospital stays,edema,joint pain,albumin,triglycerides,D-dimer,complement C3,complement C4,and serum calcium between lupus-related PLG and SLE without PLG(P<0.05).Logistic regression analysis showed that high albumin level is a protective factor for SLE combined with PLG,and edema is a risk factor.By ROC curve analysis,the critical value of albumin was 28.65g/L.The area under the ROC curve of the combined detection of albumin and edema was higher than that of albumin and edema separately.Conclusions1、The main manifestations of PLG are hypoproteinemia,edema,and polyserosal fluid.2.Globulin level,total protein level and leukocyte level are significantly related to lupus-related PLG,and high globulin level is a risk factor for PLG combined with SLE.3、High albumin level is a protective factor for SLE patients with PLG,and edema is a risk factor.The combined detection effect of albumin and edema is better than the detection separately.