Analysis of predictors of systemic lupus erythematosus with intestinal symptoms as the first manifestation / 中华消化杂志

ABSTRACT

Objective:To analyze the predictors of systemic lupus erythematosus (SLE) with intestinal symptoms as the first manifestation, and to provide evidence for the diagnosis and differential diagnosis of the disease.Methods:From January 2013 to June 2020, the clinical data of 165 patients diagnosed with SLE and treated at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to whether the intestinal symptoms were the first manifestations, they were divided into intestinal symptoms as the first manifestations group ( n=50) and intestinal symptoms not as the first manifestations group ( n=115). The baseline data, imaging findings, orgen involvement and laboratory indicators of the two groups were compared and analyzed. Independent sample t test, non-parametric test and chi-square test were used for statistical analysis. Logistic regression analysis was used to establish a prediction model of SLE with intestinal symptoms as the first manifestation. Receiver operating characteristic curve (ROC) and Hosmer-Lemeshow test were used to evaluate the predictive value of the model. From July 2020 to May 2021, the data of 72 SLE patients treated at the First Affiliated Hospital of Zhengzhou University were collected (22 patients with intestinal symptoms as the first manifestation and 50 patients with intestinal symptoms not the first manifestation), and the predictive power of the model was validated. Results:Compared with intestinal symptoms not as the first manifestation group, the proportions of patients with fever, muscle involvement and joint involvement in intestinal symptoms as the first manifestation group were lower, while the proportions of patients with polyserositis, ascites, edema and dilatation or thickening of intestines, hydronephrosis or dilatation of the ureter, kidney involvement, blood system involvement were higher, and the level of complement C3, level of complement C4, absolute lymphocyte value and albumin level were lower (67.8%, 78/115 vs. 32.0%, 16/50; 24.3%, 28/115 vs. 4.0%, 2/50; 68.7%, 79/115 vs. 14.0%, 7/50; 27.8%, 32/115 vs. 86.0%, 43/50; 16.5%, 19/115 vs. 78.0%, 39/50; 13.9%, 16/115 vs. 86.0%, 43/50; 4.3%, 5/115 vs. 62.0%, 31/50; 29.6%, 34/115 vs. 48.0%, 24/50; 30.4%, 35/115 vs. 52.0%, 26/50; 0.76 g/L, 0.43 to 0.97 g/L vs. 0.48 g/L, 0.40 to 0.57 g/L; 0.14 g/L, 0.08 to 0.23 g/L vs. 0.09 g/L, 0.06 to 0.15 g/L; 0.90×10 9/L, 0.51×10 9 to 1.28×10 9/L vs. 0.64×10 9/L, 0.44×10 9 to 1.08×10 9/L; (34.07±7.30) g/L vs. (28.77±5.43) g/L), and the differences were statistically significant ( χ2=18.246, 9.699, 41.776, 47.567, 57.781, 78.833, 67.903, 5.195 and 6.955, Z=-4.053, -3.295 and -2.204, t=-4.606; all P<0.05). The results of multivariate logistic regression analysis showed that low level of complement C3 and low albumin level were risk factors of SLE with intestinal symptoms as the first manifestation (odds ratio 0.136, 95% confidence interval 0.031 to 0.590; odds ratio 0.923, 95% confidence interval 0.871 to 0.977; P=0.008 and 0.006). The established prediction model for SLE with intestinal symptoms as the first manifestation was p=1/(1+ e - Y), in which Y=2.906-1.994×complement C3 (g/L) -0.08×albumin (g/L). The area under the ROC was 0.761 (95% confidence interval 0.687 to 0.834, P<0.01). The result of Hosmer-Lemeshow test showed the model had good calibration ability ( χ2=13.024, P=0.111). The result of validation analysis showed that when p≥0.255 to predict SLE with intestinal symptoms as the first symptoms, the sensitivity of the model was 72.7% (16/22), the specificity was 76.0% (38/50), and the accuracy was 75.0% (54/72). Conclusions:The symptoms of SLE with intestinal symptoms as the first manifestations are obscure and easily misdiagnosed. When the imaging examination of patients with intestinal symptoms as the first manifestations shows edema and dilatation or thickening of intestines, hydronephrosis or dilatation of the ureter, or laboratory examination indicates low level of complement C3 and low albumin level, be wary of the possibility of SLE. Early diagnosis and intervention can greatly improve the prognosis of patients.