| Objective:To summarize the clinic characteristics and curative effects of systemic lupus erythematosus (SLE) patients with severe thrombocytopenia, to analyze their related factors.Methods:We retrospectivly analyzed the clinical material of 94 SLE patients with severe thrombocytopenia(PLT<50×109/L)and 94 matched control patients (PLT>100×109/L) from January 2006 to December 2015 in the first affiliated hospital of GuangXi Medical University, to summarize the clinical characteristics and related risk factors of SLE patients with severe thrombocytopenia, evaluate the curative effects on severe thrombocytopenia, and examine the related factors of curative effects.Results:1. There were 94 SLE patients with severe thrombocytopenia in the observation group, including 9 males (9.6%) and 85 females (90.4%), from 10 to 84, average age 34.64 ± 15.18 years. The duration was from 3 days to 18 years, and the median duration was 5 months. The average SLEDAI score of patients in the observation group hospitalized before and after a week was 11.82±7.36, while it was 11.34±5.65 in the control group, which had no statistical significance(P>0.05).2. Comparing the two groups, the malar rash and joints impaired as the most initial symptom were less in the observation group, and during the course of disease, renal involvement, leukopenia, anemia and hemolytic anemia were more common in the observation group, while malar rash and joints impaired were less (P<0.05).3. Analyzing the laboratory examination results, the level of hemoglobin, platelet count, creatine kinase-MB was lower in the observation group, while the level of Lactate dehydrogenase, blood urea nitrogen, creatinine and 24-hour urinary protein quantity was higher than the control group(P<0.05). Beside, all the auto-antibodies, the positive rate of anti-nRNP/Sm antibody was lower in the observation group(P<0.05).4. After Logistic regression analysis, we found that the risk factors of SLE with severe thrombocytopenia were anemia and lactic dehydrogenase, and anemia had a higher risk than lactic dehydrogenase in accordance with the OR value, while the protect factors were malar rash and joints impaired(P<0.05).5.Of all 94 SLE paitients with severe thrombocytopenia,93 patients had assessment of curative effects, of whom 71 were complete response(CR,76.3%), 11 were partial response (PR,11.8%),11 were no response (NR,11.8%). There were 8 patients with refractory thrombocytopenia, while 6 patients(75%) were died. In the observe group, comparing to the ineffective group(NR), leukopenia, lower level of IgM and lower titer of anti-dsDNA were more common in the effective group(CR+PR) (P< 0.05). There was no significance in the whole effective rate between the group with PLT< 20×109/L and the group with PLT≥20×109/L (P>0.05), while, the mortality was higher signally with PLT < 20×109/L. It was not statistically significant in the whole effective rate between the methylprednisolone (MP) plus(MP>200mg/d) and the large dose of glucocorticoid (prednisone 1-2mg/Kg.d, or equal valence of MP)(P>0.05). The whole effective rate of Platelet-associated Immunoglobulin(PAIg) positive group was lower than the PAIg negative group without statistical significance (P> 0.05).The whole effective rate was lower for patients with low megakaryocyte count of bone marrow than those with normal or high megakaryocyte count of bone marrow(P<0.05).Conclusion:1.Comparing to the SLE patients with normal platelet, patients with severe thrombocytopenia have no difference with duration and disease activity, but leukopenia, anemia, hemolytic anemia, renal involvement, higher level of lactic dehydrogenase,24-hour urinary protein quantity are more common, and malar rash, joints impaired and anti-nRNP/Sm antibodies in the serum are less.2.The risk factors of SLE with severe thrombocytopenia are anemia and lactic dehydrogenase, while the protect factors are malar rash and joints impaired.3. The curative effects of the MP plus are equivalent to the large dose of glucocorticoid.4. Patients with low megakaryocyte count of bone marrow, leukopenia, low level of IgM and low titer of anti-dsDNA have bad curative effects, while The platelet count before treatment and PAIg are not related to the curative effects. |
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