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目的探讨系统性红斑狼疮(SLE)血液学改变情况。方法选取确诊为SLE且均处于活动期的43例住院患者作为研究对象,根据1997年美国风湿病学学会制定的SLE分类标准及血液学异常的诊断标准,选取合适的观察指标,包括年龄、性别、首发症状和体征,外周血象,骨髓细胞形态检查,骨髓铁染色及相关的免疫学检查,采用回顾性分析方法分析SLE血液系统异常的临床特点。结果①SLE的血液学异常发生率为69.8%。②SLE贫血和血小板减少均占55.8%,白细胞减少占39.5%,均以轻中度减少为主。③SLE更多侵犯二系及二系以上血细胞。④骨髓多见增生活跃,各系细胞比例及形态大多正常,粒系存在普遍的核左移;骨髓铁染色示铁储备不足;网状细胞与浆细胞均增生,淋巴细胞减少。⑤补体、免疫球蛋白水平与SLE血液学异常无相关性。⑥30例血细胞减少的病例,均给予糖皮质激素常规治疗,或小剂量免疫抑制剂和免疫球蛋白联合治疗,大部分治疗反应良好。结论SLE血液学异常发生率高,侵犯血系广泛。骨髓改变轻微,巨核系受累较重。治疗重点在合理应用激素及免疫抑制剂。
Objective To investigate the hematological changes of systemic lupus erythematosus (SLE). Methods Forty-three inpatients with confirmed SLE and active stage were enrolled in this study. According to the diagnostic criteria of SLE classification and hematological abnormalities established by the American College of Rheumatology in 1997, appropriate observation indexes including age, sex , Initial signs and symptoms, peripheral blood, bone marrow cell morphology, bone marrow iron staining and related immunological examination. The clinical features of SLE hematological system abnormalities were analyzed retrospectively. Results ① The incidence of hemologic abnormalities in SLE was 69.8%. ②SLE anemia and thrombocytopenia accounted for 55.8%, leukopenia accounted for 39.5%, were mild to moderate reduction. ③ SLE more violations of secondary and secondary blood cells. ④ bone marrow hyperplasia more active, most of the cells in the proportion and morphology of normal, there is widespread nuclear left shift; bone marrow iron staining showed iron reserve; reticulocytes and plasma cells were hyperplasia, lymphopenia. ⑤ complement, immunoglobulin levels and SLE hematological abnormalities no correlation. ⑥ 30 cases of cytopenia cases were given conventional glucocorticoid therapy, or low-dose immunosuppressive agents and immunoglobulin combined treatment, most of the response to treatment. Conclusion The incidence of SLE hematological abnormalities is high and the blood line is extensive. Minor changes in bone marrow, megakaryocytosis heavier. Treatment focuses on the rational use of hormones and immunosuppressive agents.