脾臟切除在紅斑性狼瘡併頑固性血小板減少症之療效及對疾病活性之影響

Splenectomy in systemic lupus erythematosus with refractory thrombocytopenia: efficacy for thrombocytopenia and effects on lupus disease activities

脾切除術在治療系統性紅斑狼瘡（SLE）併頑固性血小板減少症的療效仍然是一個有爭議的問題。我們回顧性調查10例SLE患者因頑固性血小板減少症接受脾切除手術，比較他們術前術後的狼瘡疾病活性及對血小板過低之療效。我們的研究結果顯示，血小板減少症對脾切除有良好的效果，一半的病患可達到完全緩解（Complete remission = 50％）和部分改善（Partial remission = 30％）以及維持長達五年以上並無復發的發生。然而，與脾切除術前相比SLE疾病活動性，我們觀察到在術後6個月有5例惡化，而在術後12個月的患者中有4（40％）例疾病活性增加的趨勢。腎臟是主要受影響的器官。令人驚訝的是，在10名患者中，有兩位數年後罹患類風濕關節炎。因此，我們的結論，對於治療頑固性血小板減少脾切除術是安全和有效的，值得注意的是在術後SLE疾病活性增加的機率並不低，甚至發展類風濕關節炎的風險。

The precise role of splenectomy in the treatment of refractory thrombocytopenia associated with systemic lupus erythematosus (SLE) remains a matter of debate. We retrospectively investigated the efficacy of splenectomy in 10 SLE patients who received splenectomy for thrombocytopenia and compared their lupus disease activity before and after operation. Our study showed that the response of thrombocytopenia to splenectomy achieved complete remission in 5 (50%) patients and partial improvement in 3 (30%) patients and the response sustained in the long-term follow-up period. However, compared with disease activity prior to splenectomy, we observed that lupus flare occurred in 5 (50%) patients at 6 months, and in another 4 (40%) patients at 12 months after operation. Kidney was the most frequently affect organ in flare. Surprisingly, among the 10 patients, two developed typical rheumatoid arthritis later. Thus we concluded that splenectomy was safe and effective in the treatment of refractory thrombocytopenia in SLE. Physician should be alert to disease flare and the development of rheumatoid arthritis in the post operative course.