Systemic lupus erythematosus in a multiethnic US cohort, XXXVII:: Association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual
Systemic lupus erythematosus in a multiethnic US cohort, XXXVII:: Association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual
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DOI：
10.1002/art.22224
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发表时间：
2006-10-15
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影响因子：
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通讯作者：
Reveille, John D.
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文献类型：
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作者：
Vila, Luis M.;Alarcon, Graciela S.;Reveille, John D.
目标。目的：探讨淋巴细胞减少是否与系统性红斑狼疮（SLE）的临床/免疫表现、疾病活动性和疾病损害相关。该研究组包括591名SLE患者，他们参与了一项多种族的纵向结果研究。在入组（TO）和最后一次访问（TL）时获得累积临床/免疫（根据美国风湿病学会标准）和药理学治疗变量。淋巴细胞减少（< 1,500/mm(3)）仅在临床可归因于SLE而非药物或其他原因时进行评分。淋巴细胞计数根据系统性狼疮活动测量（SLAM）分为4类：正常（>= 1,500/mm(3)），轻度（1,000-1,499/mm(3)），中度（500 - 999/mm(3)）和标记（< 500/mm(3)）。用SLAM和医师总体评估（PGA）评估疾病活动性。疾病损害由系统性狼疮国际合作诊所损害指数（SLICC-DI）确定。首先检查淋巴细胞减少与累积临床/免疫和药物治疗变量的关系，然后通过广义估计方程（GEE）回归分析检查SLAM、PGA和SLICC-DI评分与不同类型淋巴细胞减少的关系。种族、年龄和性别被纳入所有回归模型。在TO和TL，淋巴细胞减少被发现与肾脏受累、白细胞减少、抗双链DNA抗体、抗ro抗体以及糖皮质激素、硫唑嘌呤和甲氨蝶呤的使用呈正相关，但与光敏性呈负相关。在GEE分析中，在所有就诊中，明显的淋巴细胞减少和中度淋巴细胞减少与较高的SLAM、PGA和SLICC-DI评分独立相关。淋巴细胞缺乏与SLE的几种临床/免疫表现有关。中度和显著的淋巴细胞减少与较高的疾病活动性和损害累积有关。
Objective. To determine if lymphopenia is associated with clinical/immunologic manifestations, disease activity, and disease damage in systemic lupus erythernatosus (SLE).Methods. The study group comprised 591 patients with SLE participating in a multiethnic, longitudinal outcome study. Cumulative clinical/immunologic (per American College of Rheumatology criteria) and pharmacologic treatment variables were obtained at enrollment (TO) and last visit (TL). Lymphopenia (< 1,500/mm(3)) was scored only when clinically attributable to SLE and not to medications or other causes. Lymphocyte counts were expressed in 4 categories per the Systemic Lupus Activity Measure (SLAM): normal (>= 1,500/mm(3)), mild (1,000-1,499/mm(3)), moderate (500 - 999/mm(3)), and marked (< 500/mm(3)). Disease activity was assessed with the SLAM and the Physician's Global Assessment (PGA). Disease damage was determined with the Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). The relationship of lymphopenia with cumulative clinical/immunologic and pharmacologic treatment variables was first examined, then the association between the SLAM, PGA, and SLICC-DI scores with different categories of lymphopenia was examined by generalized estimating equation (GEE) regression analyses. Ethnicity, age, and sex were entered into all regression models.Results. At TO and TL, lymphopenia was found to be positively associated with renal involvement, leukopenia, anti-double-stranded DNA antibodies, anti-Ro antibodies, and the use of glucocorticoids, azathioprine, and methotrexate, but was negatively associated with photosensitivity. On GEE analyses, marked lymphopenia at To and moderate and marked lymphopenia for all visits were independently associated with higher SLAM, PGA, and SLICC-DI scores.Conclusion. Lym hopenia is associated with several clinical/immunologic manifestations in SLE. Moderate and marked lymphopenia are associated with higher disease activity and damage accrual.