Clinical characteristics and risk factors of gastrointestinal involvement in patients with systemic lupus erythematosus / 中华风湿病学杂志

ABSTRACT

Objective:To study the clinical features and prognostic risk factors of gastrointestinal (GI) involvement in systemic lupus erythematosus (SLE), and improve clinicians' understanding of GI involvement in SLE.Methods:The clinical data of SLE patients admitted to the First Affiliated Hospital of Guangxi Medical University from September 1, 2012 to September 1, 2019 were retrospectively analyzed. Two hundred and forty-three patients with GI system involvement were the GI system affected group, and 486 patients with-out GI system involvement at the same period were randomly selected as the control group. The clinical mani-festations, laboratory tests and treatment effects of the two groups were compared by t test, Wilcoxon signed-rank test and χ2 test and Logistic regression was used to analyze the prognostic risk of SLE with GI system involvement. Results:① There were 243 SLE patients with GI involvement, with the proportion of GI involvement in SLE patients of 6.4%(243/3 820), and as the first manifestation with GI system symptoms accounted for 20.2%(49/243). The common causes were lupus hepatitis accounted for 52.3%(127/243), lupus mesenteric vasculitis (LMV) for 35.0%(85/243), pseudo Intestinal obstruction (IPO) for 9.9%(24/243), lupus-related pancreatitis for 8.6%(21/243), and protein-losing enteropathy (PLE) as 7.0%(17/243). ② Compared with the control group, the group with GI involvement had a lower average age [(38±14) year vs(32±15) year, t=-2.47, P=0.014], a shorter median duration of illness [12.0(3.0, 72.0) months vs 5.0(1.1, 24.8) months, Z=-5.67 , P<0.001], a higher median systemic lupus erythematosus disease activity index (SLEDAI) score [10(6,28) vs 16(9, 37), Z=2.24 , P<0.001], the occurrence of skin rash (38.7% vs 53.5%, χ2=14.46), arthritis (36.4% vs 46.7%, χ2=7.12 , P=0.008), myositis (43.0% vs 56.4%, χ2=11.53 , P=0.001), pericarditis [(216±111)×10 9/L vs (175±114)×10 9/L, t=-4.69 , P<0.001], thrombocytopenia, and hydroureterosis (1.0% vs 12.8%, χ2=47.47 , P<0.001) were high, but the incidence of pulmonary arterial hypertension (PAH) (31.2% vs 10.7%, χ2=36.99 , P<0.001) was low; Serum alanine aminotransferase (ALT) [17(10, 29) U/L vs 59(16, 127) U/L, Z=9.65 , P<0.001], aspartate aminotransferase (AST) [25.0 (18.0, 37.0) U/L vs 82.5(25.0, 289.0) U/L, Z=10.57 , P<0.001], alkaline phosphatase (ALP) [58(46, 76) U/L vs 82(56, 187)U/L, Z=8.42 , P<0.001], Creatine kinase (CK) [44.0(28.0, 83.0) U/L vs 58.5(34.0, 176.0) U/L, Z=4.46 , P<0.001], lactate dehydrogenase (LDH) [(309±206) U/L vs (443±332) U/L, t=5.64 , P<0.001], fasting blood glucose (FBS) [(5.0±1.5) mmol/L vs (5.3±1.7) mmol/L, t=2.16 , P=0.031], triglyceride (TG) [(2.0±1.3) mmol/L vs (2.7±2.2) mmol/L, t=4.55 , P<0.001] increased, albumin (ALB) [(30±7) g/L vs (27±7) g/L, t=5.87 , P<0.001)] and high-density lipoprotein (HDL) [(1.1±0.8) mmol/L vs (0.9±0.5) mmol/L, t=-4.20 , P<0.001] decrease, and anti SSB antibody positive rate (16.0% vs 9.5%, χ2=5.60 , P=0.018) decreased.③ After 3 months' follow-up, 203 patients with SLE GI involvement were relieved, 30 patients (12.3%) died, and 9 patients (1.8%) died in the control group. Ninety-five (46.8%) patients in the remission group had a significantly higher rate of cyclophosphamide treatment when compared with 5(12.5%) in the non-remission group ( χ2=16.23, P<0.001) . Logistic regression analysis showed that no increase of PAH, elevated erythrocyte sedimentation rate (ESR), ALT, glutamyl transpeptidase (GGT), indirect bilirubin (IBIL) and high SLEDAI scores, hydroureteral dilatation, decreased ALB and HDL were independent related factors for SLE GI involvement, while ascites and elevated FBS were SLE GI involvement factors of poor prognosis. Conclusion:SLE patients with GI involvement have a high mortality rate, and lupus hepatitis and LMV are common. Hydroureterosis, high SLEDAI score, abnormal liver function are risk factors for GI involvement. Jaundice and elevated FBS are the risk factors for poor prognosis, and treatment with cyclophosphamide is the protective factor.