A positive direct Coombs' test in the absence of hemolytic anemia predicts high disease activity and poor renal response in systemic lupus erythematosus
A positive direct Coombs' test in the absence of hemolytic anemia predicts high disease activity and poor renal response in systemic lupus erythematosus
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DOI：
10.1177/0961203318809182
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发表时间：
2018-12-01
期刊：
影响因子：
2.6
通讯作者：
Kawahata, K.
中科院分区：
文献类型：
--
作者：
Hanaoka, H.;Iida, H.;Kawahata, K.
我们确定了在没有溶血性贫血的情况下，直接Coombs试验作为系统性红斑狼疮（SLE）疾病活动和治疗反应的指标的临床实用性。回顾性评估了2016年1月至2016年11月期间在我院就诊的无溶血性贫血的SLE患者，并进行了直接Coombs试验。分析SLE疾病活动指数（SLEDAI）、治疗和实验室检查结果等临床特征。对于狼疮性肾炎患者，我们还评估了诱导治疗后一年内的累积完全肾反应率。在评价的182例患者中，10例（5.8%）患者在无溶血性贫血的情况下直接Coombs试验阳性。与阴性者相比，他们有更高的SLEDAI（p < 0.01），更高的循环免疫复合物水平（p = 0.01），更高的抗DNA滴度（p < 0.01）和更低的完全肾反应率（p = 0.03）。多因素分析显示，SLEDAI是直接Coombs试验无溶血性贫血的独立相关因素（优势比2.4，95%可信区间1.66-4.98，p < 0.01）。因此，在没有溶血性贫血的情况下，直接Coombs试验阳性可能是评估疾病活动和治疗反应的有用生物标志物。
We determined the clinical utility of the direct Coombs' test in the absence of hemolytic anemia as an indicator of disease activity and therapeutic response in systemic lupus erythematosus (SLE). SLE patients without hemolytic anemia who visited our hospital from January 2016 to November 2016 were retrospectively evaluated with a direct Coombs' test. Clinical features, including SLE disease activity index (SLEDAI), treatment and laboratory findings were analyzed. For patients with lupus nephritis, we additionally evaluated the cumulative complete renal response rate over one year after induction therapy. Among 182 patients evaluated, 10 (5.8%) patients had a positive direct Coombs' test in the absence of hemolytic anemia. They had a higher SLEDAI (p < 0.01), higher circulating immune complex levels (p = 0.01), higher anti-DNA titers (p < 0.01) and a lower complete renal response rate (p = 0.03) compared with those who were negative. Multivariate analysis indicated that SLEDAI was an independent factor correlated with the direct Coombs' test without hemolytic anemia (odds ratio 2.4, 95% confidence interval 1.66-4.98, p < 0.01). A positive direct Coombs' test in the absence of hemolytic anemia may therefore represent a useful biomarker for assessing disease activity and therapeutic response.