The Clinical Features And Risk Factors Of 529 Systemic Lupus Erythematosus Induced Haematological Manifestations

Objective:To collect and analyze the clinical characteristics of systemic lupus erythematosus (SLE) patients with haematological manifestations who visited the Second Affiliated Hospital of Kunming Medical University. Analysis of patients are focused mainly on the clinical features, in order to examine its risk factors. This study aims to improve on the diagnosis and treatment of SLE with haematological manifestations.Methods:Inputting 1029 hospitalized SLE patients’ data of the Second Affiliatd Hospital of Kunming Medical University from 2003-2013 were systematically reviewed by using epidata software and inviding it into the haemaological system involved group (group A) and haemaological system unaffected group(group B). Using statistical software spss19.0 to make single factor analysis. To analyze the risk factors of group A by Logistic regression.44 cases of patients with bone marrow biopsy had been analyzed the bone marrow, treatment and prognosis.Results:1.The median course of these two groups are 24 months and 28 months, and there had a stastistical difference between the two groups (P<0.05). Two groups of the proportion of male smoking patients were 12.7% and 30.3% respectively, and there also had a stastistical difference between the two groups. There had no stastistical difference between the two groups including age, sex, nationality and so on.2. The median SLEDAI score were significabtly higher in patients with haematological manifestations(P<0.001). Two groups with no activity (SLEDAI score 0-4) are 85 cases and 170 cases, with severe activity (SLEDAI score≥15) were 87 and 37, there had a stastistical difference between the two groups (P<0.05).3. The misdiagnosed patients of group A were 89 cases(16.8%), and 38cases(42.7%) misdiagnosed as simple haematologic diseases.4. The proportion of circulatory system damage were 6.4% and 3.0% in two group, kidney damage were 23.8%, and 17.8%, serositis were 18.0% and 10.2%, the former was higher than the latter. There had a stastistical difference between the two groups (P<0.05).5. A group of anti-nuclear antibodies grade, anti Jo-1 antibody level, hs-CRP levels, ds-DNA titers were higher than group B, C3 and C4 levels lower than group B. There had a stastistical difference between the two groups (P<0.05).6. Logistic regression analysis showed that the circulatory system (OR=5.20), kidney damage (OR=2.52) were risk factors, and high nucleosome level (OR=0.56), low SLEDAI (OR=0.92) Rating were protective factors.7. Bone marrow findings of 44 cases included mainly proliferation, and part of hematological sytem had dydmaturity megalocaryocate.5 cases of bone marrow hyperplasia showed pancytopenia in peripheral blood, but the reticulocyte count is normal or elevated.38 cases were made bone marrow biopsy, and focal hyperplasia of fibrous tissue can be seen in 5 cases.8.44 patients who made bone marrow biopsy were treated with corticosteroids, immunosuppressants or venous blood return to gamma globulin (IVIG) or plasmapheresis discharging normal in 18 cases, blood improved in 12 cases, and blood had no significant changes in 6 patients; 4 in 5 patients with severe pancytopenia patients treated with IVIG of blood return 1-2 tie, two cases of patients with severe cytopenia after plasmapheresis blood return 1-2 tie.Conclusions:1. SLE disease activity in patients with blood system involvement than non-affected patients blood system.2. Combined with cycle system and kidney damage in SLE patients are more vulnerable to damage blood system, high nucleosome level and low SLEDAI score are SLE cytopenias protective factors.3. SLE combined bone marrow blood system injury is not specific, the vast majority of bone marrow showed hyperplasia, may also have dysplasia. The marrow changes and the circumference blood picture change likely not parallel.4. Steroids joint with using immunosuppressive drugs or IVIG not only does not inhibit the proliferation of the bone marrow, but can suppress the immune hyperactive bone marrow, peripheral blood cells promote proliferation.