Analysis Of Anemia In Female Patients With Lupus Nephritis And It’s Influencing Factors

Objective:To investigate and analyze the relationship between the hematological abnormalities and laboratory indexes and renal pathology in lupus nephritis, to further understand the situation and the reasons of anemia in patients with lupus nephritis, in order to improve the clinical prognosis and living quality of LN patients.Methods: 146 patients with LN in our hospital were enrolled in our study from Jan.2003 to Dec.2015. According to inclusion and exclusion criteria, 129 patients were included finally. The general condtion,clinical manifestation,laboratory indexes and pathology data were analyzed retrospectively. Patients were classified as non-anemic group(Hb≥110) and anemia group(Hb<110) first, analyze the reasons of anemia. According to oligoleukocythemia or thrombocytopenia, patients with anemia were classified as simple anemia group and anemia combined with two series decreased(oligoleukocythemia or thrombocytopenia) or three series decreased(hereafter referred to as muti-series decrease group), analyze the reasons of anemia combined with oligoleukocythemia or thrombocytopenia. We used independent t-test,chi-square and Kruskal-wallis H test to analyze the general condtion,clinical manifestation,laboratory indexes and pathology data.Results:1. 129 cases of LN patients, eighty two(63.57%) patients were presented with hematological abnormalities, 73(89.02%) were of anemia and most of them were linght-medium normacytic anemia. 2. Compared with non-anemic group, the anemia group’s course were shorter( p<0.05), medical( including hormone, immunosuppressor and cytotoxic drugs) treatment within the first half of the admisson has significant influence on anemia in patients with LN( p<0.05). 3. Hypoproteinemia, infection, reduced Hco3-, e GFR deficiency have significant influence on anemia in patients with LN( p<0.05).4. Increased Ig G, complement C3 and C4 deficiency, anti-ds-DNA antibody positive have significant influences on anemia in patients with LN( P<0.05). 5. Pathologic type has significant influence on anemia in patients with LN( p<0.05), incidence of anemia in type III and type IV LN is higher(p<0.05). Medium-severe TIL, renal interstitial inflammatory cell infiltration, emigration of the leukocyte cells increased in the glomerular≥25%, fibrinoid necrosis/karyorrhexis≥25%, AI≥10 scores have significant influences on anemia in in patients with LN( P<0.05). 6. The logistics regression analysis shows that the Alb levels(OR=0.197, OR95%CI 0.048~0.806,p=0.024), cells increased in the glomerular≥25%(OR=7.313,OR95%CI 1.700~31.456,p=0.008), fibrinoid necrosis/karyorrhexis≥25%(OR=2.008,OR95%CI 1.066~4.090,p=0.032), complement C4 level(OR=0.121,OR95%CI 0.036~0.404,p=0.001), TIL(OR=8.661, OR95%CI 1.921~39.062, p=0.005)were independent risk factors of anemia in patients with LN( P<0.05). Anemia were positively with cells increased in the glomerular, fibrinoid necrosis/karyorrhexis and TIL, but negatively with the level of complement C4 and albumin. 7. There were significant difficiences between simple anemia group and anemia combined with oligoleukocythemia decrease or thrombocytopenia decrease group in medical( including hormone, immunosuppressor and cytotoxic drugs) treatment within the first half of the admisson( p<0.05). Conclusion: The incidence of anemia was high in LN patients, often show the normacytic anemia. Pathologic type has important influence on anemia in patients with LN, incidence of anemia in type III and type IV LN is higher. The nutritional status, renal function injury, renal active pathological changes and TIL. Immune factor is significant contributors to anemia in patients with LN, and it is the major factors of oligoleukocythemia and thrombocytopenia.