Clinical Retrospective Analysis Of Thrombocytopenia In Patients With Connective Tissue Disease

Objective: To analyze the clinical characteristics of patients with severe thrombocytopenia with different connective tissue diseases(CTDs)and to explore the treatment plan of patients with severe thrombocytopenia.Methods: 131 consecutive CTDs patients with blood platelet count less than 20×109/L on admission during January 2011 to June 2015 in our department were enrolled and checked for their survival status in September 2015.According to their diagnosis,131 patients were divided into systemic lupus erythematosus group,primary Sjogren's syndrome group and other connective tissue disease group,and no response group,partial response group and complete remission group according to curative effect and the data are described statistically using mean ± standard deviation.The comparison of measured values between the two independent groups was carried out by group t test,multi-group mean comparison by single factor ANOVA,and the SNK method was used to carry out the comparison between the two groups,the classification data were described statistically by the number of cases and composition ratio(rate),chi-square test or non-parametric test for statistical analysis.The correlation analysis between the two variables adopts Pearson linear correlation or Spearman grade correlation analysis,survival analysis adopts Kaplan-Meier method.All statistical analyses were statistically significant with bilateral test P<0.05.Results: 116(88.55%)of the patients were female.The most often seen background diseases were primary Sj?gren's syndrome(p SS)(53.43%)and systemic lupus erythematosus(SLE)(40.46%).Age on admission for SLE patients(36.7±14.1 years)was much younger than that for other patients(44.4±15.4 years for p SS and46.0±16.1 years for other CTDs,P<0.05).96 cases accompanied with various bleeding symptoms,which were more frequent in p SS patients than in SLE patients(80.00% vs 64.15%,P<0.05).The majority of patients had been treated with more than one immunosuppressive drug,however,there were still 28 patients(21.37%)failed to respond.For some of the patients with refractory diseases,mesenchymal stem cell transplantation(MSCT)was applied with a total effective rate of 65.00%.11 patients died after the follow-up for a mean time of 27.7 months,of which 7 were associated with hemorrhage.There was no difference in the survival rate among different background diseases.However,compared with those who did not gain remission,patients achieved partial or complete remission had better cumulative survival rates(P <0.01).Conclusion: Among various CTDs,severe thrombocytopenia often occurs in patients with SLE or p SS.Early response to the treatments,but not the background disease,is an important predictor of long-term prognosis.For patients with refractory thrombocytopenia,MSCT may provide an alternative therapeutic strategy.Objective: To investigate the independent factors of SLE patients with thrombocytopenia and to evaluate the effect and the degree of thrombocytopenia on survival status in SLE patients,furthermore,to provide guidance for the treatment in SLE patients with thrombocytopenia.Methods: Patients with systemic lupus erythematosus who were hospitalized in rheumatology and immunology department in 26 hospitals distributed in Jiangsu province were selected as research subjects.All patients met the ACR classification criteria and other connective tissue diseases were not involved.SLE disease activity index(SLEDAI)was used to evaluate disease activity.Patients with platelet count less than 100 ×109/L were considered as thrombocytopenia,among which,platelet count under 20 ×109/L was considered as severe thrombocytopenia,platelet count between 20×109/L and 50 ×109/L was considered as moderate thrombocytopenia,platelet count between 50×109/L and 100×109/L was considered as mild thrombocytopenia.The main statistical methods used in the paper including: t test,One-Way ANOVA,the Mann-Whitney U test,Kruskal Wallis-(KW)test,chi-square,Spearman rank correlation analysis.Binary Logistic regression and multivariate Logistic regression was used to filter the independent variables.The independent variables with P<0.10 in the single-factor analysis were incorporated into the multi-factor analysis model,and the relevant factors were screened step by step related factors.All statistical analyses were statistically significant with bilateral P<0.05.Clinical data and laboratory indicators related to platelet count were analyzed to predict risk factors related to prognosis and disease activity.Results: Thrombocytopenia is an influential factor in the survival of patientswith systemic lupus erythematosus.Both mild thrombocytopenia(OR=2.30,95%CI:1.59-3.33)and moderate reduction(OR=1.91,95%CI:1.08-3.36)increase the risk of death in patients with systemic lupus erythematosus.Musculoskeletal system damage in patients with systemic lupus erythematosus(OR=1.59,95%CI:1.05-2.40),kidney damage(OR=2.38,95%CI:1.14-5.00),age(OR=1.03,95%CI:1.01-1.05),and SLEDAI score(OR=1.05,95%CI:1.02-1.08)were independent factors that increased the incidence of thrombocytopenia.RBC count(OR=0.48,95%CI:0.31-0.73)and WBC count(OR=0.90,95%CI:0.84-0.96)were independent factors affecting thrombocytopenia.Conclusion: Thrombocytopenia is a risk factor that increases death risk in lupus patients.It is important to recognize that higher SLEDAI score and higher age are independent risk factors for thrombocytopenia.Organ systems such as the musculoskeletal system and the kidneys should be protected during treatment.