紅斑性狼瘡併狼瘡性腎炎患者出現靜脈血栓症的相關因子

Associated factors for venous thromboembolism in patients with systemic lupus erythematosus complicated with lupus nephritis

目的：靜脈血栓在紅斑性狼瘡或是持續性蛋白尿的病人並不少見，而蛋白尿也屬於紅斑性狼瘡患者合併狼瘡性腎炎時的其中一種腎臟侵犯表現，但專門針對紅斑性狼瘡患者合併狼瘡性腎炎時與靜脈血栓的研究並不多，本研究的目的是探討紅斑性狼瘡患者合併狼瘡性腎炎時是否會發生靜脈血栓栓塞的危險因子。方法：於醫學中心2001年1月至2014年5月間回顧性收集了曾經住院，診斷為全身性紅斑狼瘡併有狼瘡性腎炎的患者資料，分析有發生靜脈血栓與無靜脈血栓患者的基本資料及相關檢驗報告。結果：總共收集30例患者（24名女性，6名男性）。平均年齡36.07 ± 9.06歲。每日平均尿蛋白量為4.62 ± 3.57克。其中有4名患者曾發生過靜脈血栓（13.3％）。單變數分析發現與血栓形成相關的因子包括較低的IgG（p=0.046），低dsDNA（p=0.049），高濃度C3（p<0.0001）和C4（p=0.005），高膽固醇（p=0.036），高的低密度膽固醇（LDL）（p=0.021），低的白蛋白albumin/ C3比例（p=0.0081），以及使用降血脂藥物（p=0.016）。抗磷脂抗體對於血栓的發生並無達到統計學的意義。結論：低血清IgG和抗dsDNA，高C3和C4濃度以及低的血清白蛋白／ C3比例是紅斑性狼瘡患者併狼瘡性腎炎時是否發生靜脈血栓栓塞事件的相關因子。

Objective: Venous thromboembolism (VTE) is common in patients with systemic lupus erythematosus (SLE) as well as in patients with persistent proteinuria. Although proteinuria is frequently seen in SLE patients with lupus nephritis, few studies have focused on the factors associated with VTE among these patients. The aim of this study was to determine the factors associated with VTE among SLE patients with lupus nephritis. Methods: Patients with diagnoses of SLE with lupus nephritis who were hospitalized in Changhua Christian Hospital between January 2001 and May 2014 were included. VTE events, demographic data and laboratory data were collected retrospectively. Associated factors were evaluated and compared between the patients with and without VTE. Results: A total of 30 patients were included (24 women and 6 men). The mean age ± SD was 36.07 ± 9.06 years (range: 21-60 years). The mean daily urine protein excretion was 4.62 ± 3.57g (range: 0.96-13.4g). Thrombotic manifestations were observed in 4 patients (13.3%). Factors found to be associated with thrombosis included low IgG level (p=0.046), high C3 (p<0.0001) and C4 (p=0.005) concentrations, low anti-dsDNA (p=0.049), high cholesterol (p=0.036), high low-density lipoprotein cholesterol (p=0.021), low albumin/C3 ratio (p=0.0081), and lipid-lowering agent use (p=0.016). The presence of anti-phospholipid antibodies was not a significant factor in this study. Conclusions: Lower serum IgG, lower anti-dsDNA, higher C3 and C4 levels, and lower serum albumin/C3 ratio may be associated factors for VTE events in SLE patients complicated with lupus nephritis.