目的:探讨系统性红斑狼疮(SLE)患者并发狼疮视网膜病变(LR)的危险因素。
方法:这是一个回顾性研究,横断面研究。回顾性分析2013年6月至2023年4月北京协和医院收治的LR患者。选择年龄和性别匹配的无视网膜病变的SLE患者作为对照。医疗记录包括临床表现,收集实验室数据和眼科检查.进行单因素和多因素logistic回归分析。
结果:纳入112名LR患者(198只眼),12例(14眼)表现为视网膜大血管阻塞,100例(184只眼)仅表现为微血管病变。多变量分析表明存在溶血性贫血,血红蛋白(HGB)降低和中性粒细胞相对百分比较高是LR的独立危险因素(p<0.05)。前两个也是视网膜微血管病变的危险因素,而继发性抗磷脂综合征(APS)是大血管阻塞。在男性群体中,LR与HGB降低有显著关联,无论哪种类型的视网膜病变(p<0.05)。在女性群体中,LR与溶血性贫血显著相关,抗磷脂抗体的存在,白细胞减少和中性粒细胞百分比相对较高。具体来说,溶血性贫血(p=0.002)与视网膜微血管病变显著相关,APS(p=0.003)与大血管阻塞显著相关。
结论:LR与溶血性贫血有关,降低HGB水平和更高的中性粒细胞百分比。视网膜微血管病变占大多数病例,大血管阻塞很少见。男性和女性患者有不同的危险因素。建议早期眼科筛查,特别是对于那些有LR危险因素的人。
OBJECTIVE: To investigate the risk factors of lupus retinopathy (LR) in patients with systemic lupus erythematosus (SLE).
METHODS: This is a retrospective, cross-sectional study. LR patients admitted at Peking Union Medical College Hospital from June 2013 to April 2023 were reviewed. Age- and gender-matched SLE patients without retinopathy were selected as controls. Medical records including clinical manifestations, laboratory data and ophthalmic examination were collected. Univariate and multivariate logistic regression analyses were conducted.
RESULTS: One hundred and twelve LR patients (198 eyes) were included, with 12 cases (14 eyes) presenting with retinal macrovascular obstruction, and 100 cases (184 eyes) only exhibiting microvasculopathy. Multivariate analysis indicated the presence of haemolytic anaemia, decreased haemoglobin (HGB) and higher relative percentage of neutrophils were independent risk factors for LR (p < 0.05). The first two were also risk factors for retinal microvasculopathy, whereas secondary antiphospholipid syndrome (APS) was for macrovascular obstruction. In male group, LR had significant associations with decreased HGB, no matter which types of retinopathy (p < 0.05). In female group, LR was significantly associated with haemolytic anaemia, presence of antiphospholipid antibodies, decreased white blood cells and relative high percentage of neutrophils. Specifically, haemolytic anaemia (p = 0.002) was significantly associated with retinal microvasculopathy, and APS (p = 0.003) was significantly associated with macrovasculature obstruction.
CONCLUSIONS: LR was related to haemolytic anaemia, decreased HGB levels and higher percentage of neutrophils. Retinal microvasculopathy accounted for most cases and macrovasculature obstructions were rare. Male and female patients have distinct risk factors. Early ophthalmic screening is recommended especially for those with risk factors of LR.