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目的:探讨系统性红斑狼疮(SLE)肝损害的临床特点、肝损害发生率与SLE的病情严重程度的关系。方法:对98例SLE的临床资料进行分析,收集所有研究对象的临床资料,对肝损害组(30例)的症状与体征、病情程度、肝功能指标、影像学检查结果进行数据分析,并将其部分生化及免疫学指标与无肝损害组(68对照组)进行比较。结果:SLE患者中SLE肝损害的发生率为30.61%。肝损害组中,病情重度16例(53.33%),17例患者(56.67%)无明显自觉症状,以ALT、AST轻中度升高为主。7例患者肝脏B超异常。肝损害组患者的白细胞值明显低与无肝损害组(P<0.05)。而2组的血红蛋白、血小板、CRP、ESR、抗核抗体、抗dsDNA抗体、IgG、补体3等比较差异均无统计学意义(P均>0.05)。11例患者接受肾上腺皮质激素(激素)、免疫抑制剂(环磷酰胺、甲氨蝶呤)等药物治疗,9例在出院时复查肝功能正常或好转,另2例肝功能无明显改善;19例患者在接受激素、免疫抑制剂治疗的同时,给予护肝治疗,15例出院复查肝功能正常或好转,另4例无明显改善。而对照组68例中病情重度8例(11.76%)。结论:肝脏是SLE常见累及的靶器官之一,SLE肝损害的临床表现缺乏特异性,以轻至中度肝细胞损害多见,肝损害发生率与SLE病情严重程度成正相关、与SLE的近期预后无关、与长期预后有待进一步研究。
Objective: To investigate the clinical features of liver damage in systemic lupus erythematosus (SLE) and the relationship between the incidence of liver damage and the severity of SLE. Methods: The clinical data of 98 cases of SLE were analyzed. The clinical data of all the subjects were collected. The data of the symptoms and signs, the severity of the disease, the indexes of liver function and the imaging findings of the liver damage group (30 cases) were analyzed. Some of its biochemical and immunological indicators were compared with those without liver damage (68 control group). Results: The incidence of SLE liver damage in SLE patients was 30.61%. In the liver damage group, 16 cases (53.33%) were severe and 17 cases (56.67%) had no obvious symptoms, with mild to moderate increase of ALT and AST. Seven patients had abnormal liver B-wave. Patients with liver damage had significantly lower leukocyte counts and no liver damage (P <0.05). There was no significant difference in hemoglobin, platelet, CRP, ESR, antinuclear antibody, anti-dsDNA antibody, IgG, complement 3 among the two groups (all P> 0.05). Eleven patients were treated with drugs such as corticotropin (hormone) and immunosuppressive agents (cyclophosphamide and methotrexate). Nine patients had normal or improved liver function at discharge and no significant improvement in the other two patients. Cases of patients receiving hormones, immunosuppressive therapy at the same time, given liver protection treatment, 15 cases were discharged to check the normal or improved liver function, and the other 4 cases no significant improvement. The control group of 68 patients with severe disease in 8 cases (11.76%). Conclusions: The liver is one of the most commonly involved target organs of SLE. The clinical manifestations of SLE liver damage are not specific. The mild to moderate hepatocellular damage is more common. The incidence of liver damage is positively correlated with the severity of SLE. Has nothing to do with long-term prognosis yet to be further studied.