系统性红斑狼疮患者溶血性贫血的相关特征及其影响：来自多民族队列的LX结果
Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort.
作者信息
Durán Sergio, Apte Mandar, Alarcón Graciela S, Marion Miranda C, Edberg Jeffrey C, Kimberly Robert P, Zhang Jie, Langefeld Carl D, Vilá Luis M, Reveille John D
机构信息
University of Alabama at Birmingham, AL, USA.
出版信息
Arthritis Rheum. 2008 Sep 15;59(9):1332-40. doi: 10.1002/art.24020.
OBJECTIVE
To examine the clinical and genetic correlates of hemolytic anemia and its impact on damage accrual and mortality in systemic lupus erythematosus (SLE) patients.
METHODS
SLE patients (American College of Rheumatology [ACR] criteria) of Hispanic (Texan or Puerto Rican), African American, and Caucasian ethnicity from the LUMINA (LUpus in MInorities, NAture versus nurture) cohort were studied. Hemolytic anemia was defined as anemia with reticulocytosis (ACR criterion). The association between degrees of hemolytic anemia and socioeconomic/demographic, clinical, pharmacologic, immunologic, psychological, and behavioral variables was examined by univariable and multivariable (proportional odds model) analyses. Genetic variables (FCGR and Fas/Fas ligand polymorphisms) were examined by 2 degrees of freedom test of association and Cochran-Armitage trend tests. The impact of hemolytic anemia on damage accrual and mortality was examined by multivariable linear and Cox regression analyses, respectively.
RESULTS
Of 628 patients studied, 90% were women, 19% were Texan Hispanic, 16% were Puerto Rican Hispanic, 37% were African American, and 28% were Caucasian. Sixty-five (10%) patients developed hemolytic anemia at some time during the disease course, 83% at or before diagnosis. Variables independently associated with degrees of hemolytic anemia were African American ethnicity, thrombocytopenia, and the use of azathioprine. Hemolytic anemia was associated with damage accrual after adjusting for variables known to affect this outcome; however, hemolytic anemia was not associated with mortality.
CONCLUSION
The association of hemolytic anemia with thrombocytopenia suggests a common mechanism in their pathophysiology. Hemolytic anemia is an early disease manifestation and is associated with African American ethnicity and the use of azathioprine; it appears to exert an impact on damage but not on mortality.
目的
研究溶血性贫血的临床和遗传相关性及其对系统性红斑狼疮（SLE）患者损伤累积和死亡率的影响。
方法
对来自LUMINA（少数族裔狼疮，先天与后天）队列的西班牙裔（德克萨斯州或波多黎各裔）、非裔美国人和白种人SLE患者（符合美国风湿病学会[ACR]标准）进行研究。溶血性贫血定义为伴有网织红细胞增多的贫血（ACR标准）。通过单变量和多变量（比例优势模型）分析，研究溶血性贫血程度与社会经济/人口统计学、临床、药理学、免疫学、心理学和行为变量之间的关联。通过2自由度关联检验和 Cochr an - Armitage趋势检验研究遗传变量（FCGR和Fas/Fas配体多态性）。分别通过多变量线性回归和Cox回归分析，研究溶血性贫血对损伤累积和死亡率的影响。
结果
在研究的628例患者中，90%为女性，19%为德克萨斯州西班牙裔，16%为波多黎各裔西班牙裔，37%为非裔美国人，28%为白种人。65例（10%）患者在疾病过程中的某个时间出现溶血性贫血，83%在诊断时或诊断前出现。与溶血性贫血程度独立相关的变量是非裔美国人种族、血小板减少症和硫唑嘌呤的使用。在对已知影响这一结果的变量进行调整后，溶血性贫血与损伤累积相关；然而，溶血性贫血与死亡率无关。
结论
溶血性贫血与血小板减少症的关联提示它们在病理生理学上有共同机制。溶血性贫血是一种早期疾病表现，与非裔美国人种族和硫唑嘌呤的使用有关；它似乎对损伤有影响，但对死亡率没有影响。
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