| Objective:To analyze the clinical characteristics,treatment and blood cell count recovery of hematological damage in patients with newly diagnosed systemic lupus erythematosus(SLE).Methods: From April 2012 to July 2019,365 patients with newly diagnosed SLE were selected from the Department of Rheumatology and Immunology,the first affiliated Hospital of Bengbu Medical College.According to the presence or absence of hematological damage,patients were divided into two groups: group with hematological damage and group without hematological damage.The classification and proportion of hematological damage were analyzed.According to the presence or absence of anemia,patients were divided into anemia group and non-anemia group.According to the presence or absence of leukopenia(LP),patients were divided into LP group and non-LP group.According to the presence or absence of thrombocytopenia(TP),patients were divided into TP group and non-TP group.The general data,clinical manifestations and laboratory indexes of patients in two groups were analyzed.The bone marrow cellularity,treatment and blood cell count recovery of patients in anemia group,LP group and TP group were analyzed.Results:1.Among the 365 patients with newly diagnosed SLE,there were 298 patients with hematological damage,accounting for 81.6%.Anemia is the most common manifestation of hematological damage.Anemia combined with leukopenia is the most common manifestation of combined damage.2.There were 239 patients(65.5%)in anemia group.The incidence of fever,mucosal ulcer,serositis,pulmonary hypertension and lupus nephritis(LN)in anemia group were higher than those in non-anemia group.The positive rate of anti-ds-DNA and anti-Ribo P in anemia group were higher than those in non-anemia group.The level of Ig G,ESR and CRP in anemia group were higher than those in non-anemia group.The SLEDAI score of anemia group was higher than that in non-anemia group.The levels of complement C3 and C4 in the anemia group were lower than those in non-anemia group.The most common type of anemia is anemia of chronic disease(ACD).The incidence of autoimmune hemolytic anemia(AIHA)was 4.2%.The remission rate of anemia group was 84.5%.The remission rate of AIHA was55.6%.3.There were 191 patients(52.3%)in LP group.The incidence of fever in LP group was higher than that in non-LP group.The positive rate of anti-ds-DNA,anti-Ribo P and anti-SSA-Ro60 in LP group were higher than those in non-LP group.The level of CRP in LP group was higher than that in non-LP group.The SLEDAI score was higher than that in non-LP group.The levels of complement C3 and C4 in LP group were lower than those in non-LP group.Multivariate logistic regression analysis showed that positive anti-SSA-Ro60 was an independent risk factor for LP.87 patients(45.5%)with LP had infection,of which the most common site of infection was respiratory system.The incidence of infection in patients with severe lymphocytopenia was higher than that in patients with non-severe lymphocytopenia.The remission rate of LP group was 87.5%.4.There were 94 patients(25.8%)in TP group.The incidence of lupus nephritis in TP group was higher than that in non-TP group.While the incidence of arthritis in TP group was lower than that in non-TP group.The SLEDAI score in TP group was higher than that in non-TP group.The levels of complement C3 and C4 in TP group were lower than those in non-TP group.Multivariate logistic regression analysis showed that arthritis was a protective factor for TP.The remission rate of TP group was 73.0%.The remission rate of moderate TP was 68.8%.The remission rate of severe TP was 50%.5.The erythrocytic series of bone marrow cytology in anemia group and the granulocytic series of bone marrow cytology in LP group were mainly hyperplastic,and Megakaryocytes proliferated actively in bone marrow cytology of TP group,mainly with maturation disorder.Conclusion:1.The incidence of hematological damage is high in patients with newly diagnosed SLE.2.Most patients with anemia,leukopenia and thrombocytopenia were relieved and maintained after treatment.3.About half of the patients with autoimmune hemolytic anemia and severe thrombocytopenia and a small number of patients with moderate thrombocytopenia could not be relieved after treatment.4.The bone marrow cytology of SLE hematological damage was not specific,and most of them showed hyperplastic and active myelogram.Megakaryocytes were mainly mature disorders.5.Positive anti-SSA-Ro60 antibody is an independent risk factor for leukopenia. |
