Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University Hospital, Thailand.
Rheumatology (Oxford). 2021 Nov 3;60(11):5185-5193. doi: 10.1093/rheumatology/keab217.
The prevalence and associations of leucopenia in SLE remain incompletely understood. We evaluated associations of disease activity and medication use with leucopenia (lymphopenia and neutropenia) in a multinational, prospectively followed SLE cohort.
Data from the Asia Pacific Lupus Collaboration cohort, in which disease activity and medications were prospectively captured from 2013 to 2018, were used. Predictors of lymphopenia (lymphocyte count <0.8 × 109/l) and neutropenia (neutrophil count <1.5 × 109/l) were examined using multiple failure, time-dependent survival analyses.
Data from 2330 patients and 18 287 visits were analysed. One thousand and eighteen patients (43.7%) had at least one episode of leucopenia; 867 patients (37.2%) had lymphopenia, observed in 3065 (16.8%) visits, and 292 (12.5%) patients had neutropenia, in 622 (3.4%) visits. After multivariable analyses, lymphopenia was associated with overall disease activity, ESR, serology, prednisolone, AZA, MTX, tacrolimus, CYC and rituximab use. MTX and ciclosporin were negatively associated with neutropenia. Lupus low disease activity state was negatively associated with both lymphopenia and neutropenia.
Both lymphopenia and neutropenia were common in SLE patients but were differentially associated with disease and treatment variables. Lymphopenia and neutropenia should be considered independently in studies in SLE.
系统性红斑狼疮（SLE）患者白细胞减少症的患病率及其相关因素尚未完全阐明。我们评估了疾病活动度和药物使用与白细胞减少症（淋巴细胞减少症和中性粒细胞减少症）在一个多国家、前瞻性随访的 SLE 队列中的关联。
使用亚太狼疮协作队列的数据，该队列从 2013 年至 2018 年前瞻性地捕获了疾病活动度和药物使用情况。使用多重失效、时间依赖性生存分析来检查淋巴细胞减少症（淋巴细胞计数<0.8×109/l）和中性粒细胞减少症（中性粒细胞计数<1.5×109/l）的预测因子。
共分析了 2330 例患者和 18287 次就诊的数据。1018 例患者（43.7%）至少有一次白细胞减少症发作；867 例患者（37.2%）发生淋巴细胞减少症，见于 3065 次（16.8%）就诊，292 例患者（12.5%）发生中性粒细胞减少症，见于 622 次（3.4%）就诊。多变量分析后，淋巴细胞减少症与总体疾病活动度、ESR、血清学、泼尼松龙、AZA、MTX、他克莫司、环磷酰胺和利妥昔单抗的使用相关。MTX 和环孢素与中性粒细胞减少症呈负相关。狼疮低疾病活动状态与淋巴细胞减少症和中性粒细胞减少症均呈负相关。
SLE 患者中淋巴细胞减少症和中性粒细胞减少症均很常见，但与疾病和治疗变量的相关性不同。在 SLE 研究中应分别考虑淋巴细胞减少症和中性粒细胞减少症。
