系统性红斑狼疮患者的非甲状腺疾病综合征：与疾病炎症活动的关系。
Non-thyroidal disease syndrome in patients with systemic lupus erythematosus: relation to disease inflammatory activity.
作者信息
Meng Xue, Lv Ang, Tang Mulin, Liu Xue, Wang Xinhui, Li Yuchen, Chai Yuwei, Yang Qingqing, Kou Chunjia, Zhang Li, Li Ming, Zhang Haiqing
机构信息
Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
出版信息
Clin Rheumatol. 2024 May;43(5):1551-1558. doi: 10.1007/s10067-024-06947-y. Epub 2024 Apr 5.
OBJECTIVE
To identify risk factors for the development of non-thyroidal illness syndrome (NTIS) in patients with systemic lupus erythematosus (SLE).
METHODS
A retrospective analysis of 517 SLE patients and 1034 age-and sex-matched healthy population was conducted to compare the prevalence of NTIS in these two groups, and to analyze the laboratory and clinical characteristics of SLE patients with NTIS. Finally Logistic regression analysis was used to determine the risk factors for NTIS in SLE patients.
RESULTS
The prevalence of NTIS in the SLE patients was significantly higher than that in controls (39.7% vs. 1.0%, P < 0.001). In SLE patients, compared with euthyroidism patients, NTIS patients exhibited higher levels of neutrophils, hepatic enzymes, kidney damage markers, inflammatory markers and SLE disease activity index (SLEDAI). They also had a higher incidence of organ insufficiency and positive antibodies such as anti-ds-DNA antibodies and anti-SSA antibodies. However, NTIS patients had lower levels of hemoglobin, lymphocytes, platelets, serum albumin, and complement. Additionally, NTIS patients had a shorter duration of lupus and lower utilization of disease-modifying antirheumatic drugs (DMARDs) (P < 0.05). Logistic regression analysis showed that elevated SLEDAI (OR = 1.060, 95%CI 1.022-1.099, P = 0.002), elevated systemic immune-inflammation index (SII) (OR = 1.003, 95%CI 1.001-1.007, P = 0.026), elevated erythrocyte sedimentation rate (ESR) (OR = 1.019, 95%CI 1.010-1.028, P < 0.001), and hepatic insufficiency (OR = 1.916, 95% CI 1.173-3.131, P = 0.009) were independent risk factors for the development of NTIS in SLE. DMARDs treatment (OR = 0.495, 95% CI 0.306-0.799, P < 0.001) was an independent protective factor for NTIS.
CONCLUSIONS
Inflammatory activity in SLE patients is associated with the development of NTIS. Key Points • Inflammatory activity indexes such as SLEDAI, SII, and ESR are independent risk factors for NTIS in SLE patients.
目的
确定系统性红斑狼疮（SLE）患者发生非甲状腺疾病综合征（NTIS）的危险因素。
方法
对517例SLE患者和1034例年龄及性别匹配的健康人群进行回顾性分析，比较两组中NTIS的患病率，并分析发生NTIS的SLE患者的实验室检查和临床特征。最后采用Logistic回归分析确定SLE患者发生NTIS的危险因素。
结果
SLE患者中NTIS的患病率显著高于对照组（39.7% 对1.0%，P < 0.001）。在SLE患者中，与甲状腺功能正常的患者相比，发生NTIS的患者中性粒细胞、肝酶、肾损伤标志物、炎症标志物及SLE疾病活动指数（SLEDAI）水平更高。他们器官功能不全以及抗双链DNA抗体和抗SSA抗体等阳性抗体的发生率也更高。然而，发生NTIS的患者血红蛋白、淋巴细胞、血小板、血清白蛋白和补体水平较低。此外，发生NTIS的患者狼疮病程较短，使用改善病情抗风湿药物（DMARDs）的比例较低（P < 0.05）。Logistic回归分析显示，SLEDAI升高（OR = 1.060，95%CI 1.022 - 1.099，P = 0.002）、全身免疫炎症指数（SII）升高（OR = 1.003，95%CI 1.001 - 1.007，P = 0.026）、红细胞沉降率（ESR）升高（OR = 1.019，95%CI 1.010 - 1.028，P < 0.001）以及肝功能不全（OR = 1.916，95%CI 1.173 - 3.131，P = 0.009）是SLE患者发生NTIS的独立危险因素。DMARDs治疗（OR = 0.495，95%CI 0.306 - 0.799，P < 0.001）是NTIS的独立保护因素。
结论
SLE患者的炎症活动与NTIS的发生有关。要点• SLEDAI、SII和ESR等炎症活动指标是SLE患者发生NTIS的独立危险因素。
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