Clinical characteristics of systemic lupus erythematosus complicated with thrombocytopenia

Clinical characteristics of systemic lupus erythematosus complicated with thrombocytopenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical characteristics of systemic lupus erythematosus complicated with thrombocytopenia Yuanhong peng, Jirong Cheng, Di Ma, Miao He, Xing Li, Qian Wu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4874931/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To explore the clinical characteristics and treatment outcomes of systemic lupus erythematosus (SLE) complicated with thrombocytopenia (TP). Methods: The clinical data of SLE patients with TP were collected. These TP patients were matched with SLE patients without TP in the same period at a 1:1 ratio. Multivariate logistic regression analysis was used for comparison. Results: The incidence of leukopenia, anemia, lupus nephritis, and hyper-IgG in the TP group increased significantly. Additionally, the SLEDAI score in the TP group was higher ( P <0.05), while the incidence of anti-u1-RNP antibody and anti-SSA antibody was lower than that in the non-TP group ( P <0.05). Multivariate logistic analysis revealed that leukopenia, anemia, and lupus nephritis were independent risk factors for TP ( P 20×10^9/L), and 40 patients with severe TP (PLT ≤ 20×10^9/L). The number of bone marrow megakaryocytes (MK) in the mild and moderate TP group [19.5 (8, 41.25)] was lower than that in the severe TP group [55 (13, 142)] ( P = 0.007). Platelet MK production in the mild and moderate TP group was significantly higher than that in the severe TP group ( P =0.028). Intravenous immunoglobulin (IVIG), high-dose glucocorticoids, and tacrolimus were more commonly utilized in the severe TP group, whereas mycophenolate mofetil (MMF) was more frequently used in the mild and moderate TP groups ( P < 0.05). The effective rate of patients with severe TP was lower than that of patients with mild and moderate TP ( P < 0.05). Conclusions: TP often accompanied with anemia, leukopenia, and a high SLE Disease Activity Index (SLEDAI) score. Leukopenia, anemia, and lupus nephritis are independent risk factors for TP. Patients with severe TP tend to use high-dose glucocorticoids and IVIG, and the effective rate of treatment for mild and moderate TP is higher. The recurrence frequency of patients with severe TP after complete remission is significantly higher than that of patients with mild and moderate TP. lupus erythematosus systemic immune thrombocytopenia Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by immune system disorders that can affect multiple organs. 1, 2 Thrombocytopenia (TP) is one of the manifestations of hematological involvement closely related to other systemic damage, disease activity, and prognosis of SLE 3-5 . With advancements in clinical diagnosis and treatment, most patients respond well to treatment. However, some patients still exhibit a poor response to treatment, with TP persisting or recurring 6 . Through a retrospective study, we analyzed the clinical data of SLE patients with TP and compared them with those of SLE patients without TP to elucidate the clinical characteristics of SLE patients with TP. Methods Clinical data A total of 1544 inpatients with SLE diagnosed by the Department of Rheumatology and Immunology at the affiliated Hospital of North Sichuan Medical College from December 2019 to December 2023 were collected. Other diseases that could lead to TP, such as primary hematological diseases, drugs, pregnancy, and severe infection, were excluded. 107 patients with SLE related thrombocytopenia were included in this study. In the control group, Using a random number table method with a ratio of 1:2, 107 SLE inpatients without ITP who complained of rash and joint pain during the same period were selected as the non ITP group. The diagnosis of SLE was made according to the revised SLE classification criteria established by the American College of Rheumatology in 1997. TP is defined as the occurrence of a platelet count < 100x10^9/L two or more times during the course of the disease, excluding other conditions that can cause TP, including primary hematological diseases, drugs, and severe infections. 7 According to platelet count, the patients were divided into two groups: severe TP: PLT ≤ 20 × 10^9/L, and mild to moderate TP > 20 × 10^9/L. They were classified based on the degree of bone marrow hyperplasia: Active bone marrow hyperplasia showed a normal or increased number of megakaryocytes (MK) without maturation disorders, while myelodysplasia presented rare or absent MK, or maturation disorders. Refer to the Chinese guidelines for the diagnosis and treatment of Adult Primary Immune Thrombocytopenia (2020 Edition) 8 formulated by the Thrombosis and Hemostasis Group of the Chinese Medical Association. Complete response is defined as a platelet count of ≥ 100 × 10^9 / L after treatment without bleeding. Effective treatment is indicated by a platelet count of ≥ 30 × 10^9 / L after treatment, at least 2 times higher than the basal platelet count, and absence of bleeding. Ineffective treatment is defined as a platelet count of less than 30 × 10^9/L after treatment, an increase in platelet count of less than 2 times the baseline value, or the presence of bleeding. Recurrence: After effective treatment, the platelet count decreased to less than 30 × 10^9 / L, or less than 2 times the baseline value, or bleeding symptoms appeared. This study was approved by the Ethics Committee of the affiliated hospital of North Sichuan Medical College. The informed consent of all participants was obtained. Statistical analysis Normal distribution data is described using mean ± standard deviation, while non normal distribution data is described using median (P25, P75). For data with normal distribution and homogeneous variance, independent sample t-test is used for comparison between two groups, and one-way ANOVA is used for comparison between multiple groups. Further multiple comparisons will be conducted using LSD or SNK tests; For non normally distributed data, Mann Whitney U test is used for comparison between two sample groups, and Kruskal Wallace test is used for analysis of differences between multiple sample groups.The comparison between categorical variables is conducted using chi square test. Variables with a significance level below 0.2 in univariate analysis were included in multivariate logistic regression analysis (using the forward selection method) to identify factors independently associated with TP. All data analyses were performed using SPSS version 27.0. For all statistical analyses, differences were considered statistically significant when the two-sided p -value was below 0.05. Results Comparisons of clinical data between the TP and non-TP groups There were 107 cases in the TP group and 107 cases in the non-TP group. There was no significant difference in sex, course of disease, and age between the two groups ( P > 0.05), indicating that the baseline of the two groups was consistent and could be compared. Compared with the clinical data of the two groups, leukopenia, anemia, lupus nephritis, and hyper-IgG significantly increased in the TP group, while anti-u1-RNP antibody and anti-SSA antibody significantly decreased in the TP group ( P < 0.05, see Table 1). In the TP group, the SLEDAI score was higher, the anticardiolipin antibody IgM titer was higher, the absolute values of hemoglobin, white blood cells (WBC), lymphocytes, and glomerular filtration rate were lower, and urea and bilirubin were higher, with statistical differences between the two groups ( P < 0.05, see Table 2). Table 1 presents the baseline characteristics of the TP and non-TP groups. TP group n（%） Non-TP group n（%） χ 2 P -value Clinical manifestations Lupus nephritis 47（43.9%） 24（22.4%） 11.15 a ＜0.001 Serous cavity effusion 11（10.3%） 9（8.4%） 0.221 a 0.639 Mesenteric vasculitis 1（0.9%） 3（2.8%） - 0.621 Neuropsychiatric lupus 0（0%） 3（2.8%） - 0.246 Rash 21（19.6%） 25（23.4%） 0.443 a 0.506 alopecia 5（4.7%） 9（8.4%） - 0.408 Arthritis/arthralgia 17（15.9%） 16（15%） 0.036 a 0.85 Biological features Leukopenia 29（27.1%） 13(12.1%) 7.584 a 0.006 Anaemia 46(43%) 23(21.5%) 11.315 a ＜0.001 Immunological features Anti-u1-RNP antibody positivity 41(38.3%) 57(53.3%) 4.819 a 0.028 Anti-Sm antibody positivity 14(13.1%) 23(21.5%) 2.647 a 0.104 anti-nucleosome antibody positivity 27(25.2%) 34（31.8%） 1.124 a 0.289 Anti-SSA antibody positivity 48（44.9%） 66（61.7%） 6.082 a 0.014 Anti-SSB antibody positivity 17（15.9%） 18（16.8%） 0.034 a 0.853 Anti-ribosomal P protein antibody positivity 19（17.8%） 24（22.4%） 0.728 a 0.394 ANCA 22（20.6%） 17（15.9%） 0.784 a 0.376 Anticardiolipin antibody 31(29%) 31(29%) 0 1 Anti-β 2 GPⅠantibody positivity 19(17.8%) 12(11.2%) 1.848 a 0.174 Hypocomplementemia (C3) 89(83.2%) 84(78.5%) 0.754 a 0.385 Hypocomplementemia (C4) 73(68.2%) 69(64.5%) 0.335 a 0.563 Elevated IgA 46(43%) 43(40.2%) 0.173 a 0.677 Elevated IgG 16（15.0%） 7（6.5%） 3.946 a 0.047 Elevated IgM 1（0.9%） 3(2.8%) b 1.019 b 0.313 a Chi-square test; b Correction Chi-square test Table 2 Comparison of laboratory indices between TP combination and non-TP groups TP group Non-TP group t / Z P -value SLEDAI 6(2,13) 4(1,13) 2.426 0.015 ESR(mm/h) 23(11.5,49) 27(16,50) -1.058 0.29 Anti β2-GPΙ antibody 30.55(21.07,57.11) 32.27(28,73.92) 0.952 0.341 aCL IgM(RU/ml) 32.42(26.75,48.55) 26.33(22.23,31.26) -2.181 0.029 HB(g/L) 103.68±18.42 112.36±18.25 -4.303 <0.001 WBC(10E9/L) 5.06(3.62,7.51) 5.4(4.12,7.25) -2.11 0.035 Lym(10E9/L) 0.77(0.55,1.09) 1.05(0.67,1.497) -2.701 0.007 eGFR 92.8(56.85,123.35) 104.45(65.65,131.8) -1.964 0.049 Urea nitrogen 6.4(4.54,9.33) 5.23(3.69,6.72) -2.572 0.01 Indirect bilirubin 7.5(4.8,11.3) 6(5.0,7.9) -2.716 0.007 Direct bilirubin 4.2(3,6.75) 2.4(1.4,3.67) -4.829 <0.001 Adenosine deaminase 19(13.75,24) 15(11.77,21) -3.115 0.002 SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; ESR: erythrocyte sedimentation rate; HB: hemoglobin; Lym: Absolute lymphocyte count; WBC: white blood cells; eGFR: estimated glomerular filtration rate. Analysis of factors associated with TP In the univariate analysis, variables showing statistically significant differences were selected as independent variables, while the change in PLT count was designated as the dependent variable for binary logistic regression analysis. The results showed that leukopenia, anemia, and lupus nephritis were independent risk factors for TP ( P < 0.05, Table 3). Table 3 Screening independently associated factors of TP by multivariate logistic regression analysis using the forward method in SLE. B SE P -value OR (95%CI) Leukopenia 1.238 0.419 0.003 3.449(1.517~7.842) Anaemia 0.995 0.350 0.004 2.706(1.363~5.374) Nephritis -0.909 0.356 0.011 2.483(1.236~4.989) Anti-RNP antibody -1.064 0.327 0.001 0.345(0.182~0.655) Anti-SSA antibody 0.002 0.001 0.037 0.998(0.997~1.000) SLEDAI 0.009 0.028 0.739 1.009(0.956~1.066) SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; B: coefficient value; SE: standard error; 95% CI: 95% confidence interval; OR: odds ratio Intra-group analysis of the TP group Grouped according to platelet count There were 67 patients with mild and moderate TP, accounting for 62.6%, and 40 patients with severe TP, accounting for 37.3%. There were 10 males (9.3%) and 97 females (90.6%). The male-to-female ratio was 1:9.7, which was similar to the male-to-female ratio of SLE in the Chinese mainland area (1:10). 9, 10 There were 48 cases of hemorrhage, including 31 severe cases of TP and 17 mild to moderate cases of TP. There were no significant differences in sex, age, course of SLE, course of TP, clinical manifestations (rash, splenomegaly, fever, arthralgia, alopecia, ulcer, lupus nephritis, etc.), and laboratory examinations (ESR, CRP, HB, immunoglobulin, complement, etc.) between the severe TP group and the mild to moderate TP group. Analysis of the results of bone marrow puncture in the TP group Out of the 107 patients, 67 underwent bone marrow smears and pathological examinations. In the mild and moderate TP group, bone marrow examination was performed in 33 cases. Bone marrow hyperplasia decreased in 3 cases (9%), while it remained active in 30 cases (90.9%). In the severe group, bone marrow examination was performed in 34 cases. Bone marrow hyperplasia decreased in 0 cases (0%), while active bone marrow hyperplasia was observed in all 34 cases (100%). There was no significant difference in the degree of bone marrow hyperplasia between the two groups ( P > 0.05). The bone marrow MK value for the mild and moderate group was 19.5 (8, 41.25), while the bone marrow MK value for the severe group was 55 (13, 142). There was a significant difference in bone marrow MK between the two groups ( P = 0.007). According to the comparison of the degree of maturation disorder of bone marrow MK between the two groups, the average proportion of all types of MK in the total MK of bone marrow smears in the two groups was represented as the median. Immature and granular MK were dominant in both groups, but the production of platelet MK in the mild to moderate TP group was significantly higher than in the severe TP group (Table 4). Table 4 Comparison of the Degree of Maturation Disorders of Bone Marrow Megakaryocytes group n pro-MK （%） Granular-MK（%） Plate producing-MK（%） Naked-MK（%） Mild/Moderate TP 64 8.4 72.2 4.8 4 Severe TP 40 12 76 2 4 P -value 0.448 0.556 0.028 0.982 MK: megakaryocytes Correlation Analysis of Platelet Counts In the results of bivariate correlation analysis between platelet count and clinical data (Table 5), platelet count was negatively correlated with the absolute value of neutrophils and complement C3 at the lowest platelet count, and the difference was statistically significant ( P < 0.05). There was no significant correlation found with age, minimum platelet count, white blood cell count, lymphocyte count, hemoglobin, ESR, anti-ds-DNA antibody, complement C4, SLEDAI, cardiolipin-IgM, and immunoglobulin levels. Table 5 Correlation between Platelet Count and Clinical Data Platelet count r P -value Age 0.027 0.781 Neu -0.197 0.042 C3 -0.196 0.043 C4 -0.169 0.081 WBC -0.172 0.177 Lym -0.135 0.167 Hb -0.043 0.661 ESR -0.168 0.1 Anti-dsDNA antibody 0.121 0.218 SLEDAI 0.125 0.2 aCL IgM 0.24 0.218 Neu: Absolute value of neutrophils; C3: Complement C3; WBC: white blood cells; Lym: Absolute value of lymphocytes; Hb: Hemoglobin; ESR: Erythrocyte sedimentation rate; C4: Complement C4; SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; aCL IgM: Anticardiolipin antibody IgM Treatment differences and treatment responses in various groups The variances and reactions among various groups are illustrated in Table 6. The results showed that IVIG, high-dose glucocorticoids, and tacrolimus were used more frequently in the severe TP group (5 cases), mild to moderate TP group (2 cases), and Mycophenolate mofetil (MMF) mild to moderate TP group. The effective rate of patients with severe TP was significantly lower than that of mild to moderate TP ( P 0.05). The recurrence rate was higher in the severe TP group, and the difference was statistically significant ( P < 0.05). Table 6 Comparison of Therapeutic Drugs and Therapeutic Responses in Different Groups severe TP n（%） mild to moderate TP n（%） P -value GC pulse therapy（500mg/d） 5（12.2） 2（3.0%） 0.144 b A large dose of GC 25（63.4） 26（39.4） 0.016 a Immunosuppressant HCQ 27（65.9） 50（75.8） 0.268 a MMF 6（14.6） 23（34.8） 0.022 a IVIG 20（50） 10（7.6） ＜0.001 a Tacrolimus 13（31.7） 8（12.1） 0.013 a Cyclosporin 10（24.4） 10（15.2） 0.233 a Telitacicept 5（12.2） 2（3.0） 0.144 a Belimumab 3（7.3） 3（4.5） 0.862 a CTX 1（2.4） 3（4.5） 0.577 b LEF 0（0） 2（3） 0.523 b Therapeutic response Complete remission 24（58.5） 31（47） 0.244 a Effective 8（19.5） 26（39.4） 0.032 a Inefficiency 9（22） 9（13.6） 0.264 a Recurrence 11（27.5） 5（7.5) 0.005 a a Chi-square test; b Corrected Chi-square test; GC: Glucocorticoids; HCQ: Hydroxychloroquine; MMF: Mycophenolate mofetil; IVIG: intravenous immunoglobulin; CTX: cyclophosphamide; LEF: Leflunomide Discussion The incidence of TP in patients with SLE was 10~40 %. 11, 12 In 5~16% of SLE patients, it may be the first manifestation. 13 The incidence rate of TP in this study was 7.8%, lower than the reported incidence rate of 21.5% by the Chinese SLE Research Collaboration Group. 14 Foreign literature 15 has pointed out that TP can affect 7% to 30% of patients with SLE, about half of whom have TP at the beginning of diagnosis. In this study, 56 patients had TP at the beginning of the diagnosis, with an incidence rate of 52.3%. It can be seen that the incidence of TP is higher in untreated patients with primary SLE. The manifestations of TP are diverse, ranging from chronic and asymptomatic to acute or severe. Severe TP accounts for about 3%~20% prevalence of TP is often linked to the long-term progression of SLE. 16 Severe TP serves as a negative prognostic indicator for SLE and is correlated with high mortality rates. 17 Therefore, TP stands out as a significant prognostic factor for SLE, warranting clinical attention. Clinically, patients with TP are usually accompanied by damage to other systems due to disease activity. In this study, it was found that the risk of lupus nephritis in the TP group was higher than that in the non-TP group, which was consistent with findings from other clinical studies. 14, 18 The specific autoantibody of SLE is associated with its clinical manifestations, which is crucial for the diagnosis and prediction of organ damage. Related studies have confirmed that anti-dsDNA antibody, anti-Sm antibody, anti-u1-RNP antibody, and anti-rRNP antibody are associated with TP 14, 19, 20 In this study, univariate and multivariate analyses revealed that the incidence of anti-u1-RNP antibody and anti-SSA antibody in the TP group was lower than that in the non-TP group. González-Naranjo LA 21 found a correlation between anti-SSA antibodies and hematological damage, while other antibodies did not show a correlation with TP. Many studies conducted at home and abroad have confirmed the correlation between antiphospholipid antibodies and TP. 19, 22 The production of anticardiolipin antibodies (aCL) is identified as one of the primary causes of platelet destruction. 23-25 In this study, 94 patients in the TP group and 82 patients in the control group exhibited complete antiphospholipid antibody profiles. In both groups, 31 patients tested positive for anticardiolipin antibodies, with IgM being the most common type in both groups. The IgM titers of cardiolipin antibodies in the TP group and the non-TP group were 32.42 (26.75, 48.55) and 26.33 (22.23, 31.26), respectively. There was a significant difference between the two groups. It can be seen that although there was no significant difference in the detection rate of antiphospholipid antibodies between the two groups, the IgM titer of cardiolipin antibodies was higher in the TP group. Thus, we further utilized univariate analysis to examine the correlation between antiphospholipid antibody titer and platelet count, but no significant correlation was observed between them ( P > 0.05). 94 patients in the TP group were categorized into positive and negative groups depending on the presence of ACLA, with total effective rates of 79.6% and 81.4%, respectively. There was no significant difference between the two groups ( P > 0.05). The SLEDAI scores of patients in the TP group were higher than those in the non-TP group, which is consistent with relevant reports both domestically and internationally. 14, 26 Indicating that TP is a reliable factor reflecting the activity of SLE disease. 27, 28 The increase in autoantibodies during the active phase leads to increased platelet destruction. Simultaneously, it may be associated with low bone marrow proliferation and excessive cellular immunity. Patients with the initial onset of TP have higher disease activity and require active monitoring for damage to other systems and early clinical intervention. In SLE patients with TP, most of the bone marrow hyperplasia is active or hyperplastic, and MK is normal or increased to produce excessive platelets. In contrast, in the bone marrow images of patients with hypoplasia, MK is rare or absent, often accompanied by maturation disorders. 29, 30 with high disease activity there is premature apoptosis of MK a step ahead of platelet production, hence they see less platelet making MK in the severe TP group. Thrombopoietin is not the only explanation for TP in SLE. However, the degree of maturation disorder in the severe TP group was higher than that in the mild and moderate group. According to the literature. 31 It is reported that anti-thrombopoietin receptor antibodies can be detected in the sera of patients with SLE complicated by reduced platelet counts. This antibody blocks the differentiation of hematopoietic stem cells into MK induced by thrombopoietin (TPO), thus inhibiting the production of MK in SLE patients at the level of MK precursor cells. Hiroko et al. 32 detected anti-thrombopoietin antibodies in the sera of patients with SLE complicated by platelet (PLT) reduction. These antibodies neutralized TPO and decreased its levels, leading to a significant reduction in megakaryocyte (MK) production. TP is one of the common complications of SLE. Glucocorticoids, intravenous immunoglobulin, danazol, and immunosuppressants such as cyclophosphamide and splenectomy can be used to treat TP. However, glucocorticoid therapy is still a first-line treatment regimen. 33 It has definite therapeutic effects on active SLE and TP, mainly by inhibiting the production of macrophage Fc receptors. Inhibition of platelet antibody production and binding to the platelet membrane reduces their destruction, and the dosage for clinical application varies greatly. For the selection of glucocorticoid types, a recent meta-analysis showed that the total effective rate of dexamethasone was the same as that of prednisone. Moreover, the sustained effective rate of dexamethasone was higher after 12 months without changing the incidence of adverse events (relative risk 1.34). 34 GC therapy for TP typically takes effect within 2 weeks and reaches a relative peak at 6-8 weeks (63.4%). Patients with a high degree of bone marrow hyperplasia experienced better treatment outcomes. Long-term use of high-dose GC should be avoided in clinical treatment. Platelet levels below 20 × 10^9/L should be actively treated, and those above 50 × 10^9/L should be followed up. In this study, 18 patients did not respond to treatment due to low bone marrow proliferation, rare or absent MK, or maturation disorder, indicating refractory TP. In general, controlling glucocorticoids in such patients is challenging, and they often succumb to bleeding. Lidan Zhao 27 found that when patients were stratified according to BM-MK > 20/slice and BM-MK ≤ 20/slice, the SLE-TP effective rate (CR+PR) was 88% and 30%, respectively (Figure 2). The difference was statistically significant (p = 0.002). At the same time, the study conducted a logistic stepwise regression analysis and demonstrated that patients with a BM-MK count greater than 20 per tablet were more likely to exhibit a better clinical response.High-dose gamma globulin, vincristine, or splenectomy should be considered for patients with poor hormone response, hypoplasia of bone marrow, and platelet transfusion should be used if necessary to prevent bleeding. In this study, 18 patients received intravenous immunoglobulin (IVIG) at a dosage of 15g per day for 3 to 5 days. This treatment led to a rapid increase in platelet levels, but showed limited efficacy in the long term. Its effect was limited to the short term, 35 which was suitable for emergency patients. This study is a single-center small sample retrospective study. Some patients lack clinical data, which may affect the results of inter-group comparison. It will be continuously followed up in future studies. To sum up, TP is one of the common manifestations of hematological damage in patients with SLE, which is often accompanied by anemia, leukopenia, and a high SLEDAI score. Leukopenia, anemia, and lupus nephritis are independent risk factors for TP. Declarations Acknowledgements The authors would like to thank all patients and study site personnel for participating in this study. Funding This work was supported by the Municipal School Cooperative Research Special Project (Sichuan North Medical College) in Nanchong, Sichuan Province (No. 19SXHZ0140). Competing interests The author(s) declared no potential conflicts of interest with in respect to the research, authorship, and/or publication of this article. Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research. Ethics approval This study received approval from the Institutional Medical Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (2023ER180-1). References Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G. Systemic lupus erythematosus. Nat Rev Dis Primers . 2016;2:16039. DOI: 10.1038/nrdp.2016.39. Fanouriakis A, Tziolos N, Bertsias G, Boumpas DT. Update οn the diagnosis and management of systemic lupus erythematosus. 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Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort. Semin Arthritis Rheum . 2016;45:675-683. DOI: 10.1016/j.semarthrit.2015.11.003. Teke HÜ, Cansu DÜ, Korkmaz C. Detailed features of hematological involvement and medication-induced cytopenia in systemic lupus erythematosus patients: single center results of 221 patients. Eur J Rheumatol . 2017;4:87-92. DOI: 10.5152/eurjrheum.2017.160086. Macchi L, Rispal P, Clofent-Sanchez G, Pellegrin JL, Nurden P, Leng B, Nurden AT. Anti-platelet antibodies in patients with systemic lupus erythematosus and the primary antiphospholipid antibody syndrome: their relationship with the observed thrombocytopenia. Br J Haematol . 1997;98:336-341. DOI: 10.1046/j.1365-2141.1997.2243038.x. Lipp E, von Felten A, Sax H, Müller D, Berchtold P. Antibodies against platelet glycoproteins and antiphospholipid antibodies in autoimmune thrombocytopenia. Eur J Haematol . 1998;60:283-288. DOI: 10.1111/j.1600-0609.1998.tb01041.x. Petrović R, Petrović M, Novicić-Sasić D, Cirović L, Damjanov N, Palić D. Anticardiolipin antibodies and clinical spectrum of antiphospholipid syndrome in patients with systemic lupus erythematosus. Vojnosanit Pregl . 1998;55:23-28. Abdel GS, Edrees AM, Ajeeb AK, Aldoobi GS, El-Boshy M, Hussain W. Prognostic significance of platelet count in SLE patients. Platelets . 2017;28:203-207. DOI: 10.1080/09537104.2016.1214253. Zhao L, Xu D, Qiao L, Zhang X. Bone Marrow Megakaryocytes May Predict Therapeutic Response of Severe Thrombocytopenia in Patients with Systemic Lupus Erythematosus. J Rheumatol . 2016;43:1038-1044. DOI: 10.3899/jrheum.150829. Li J, Pan Z, Liu H, Ding F, Shu Q, Li X. Retrospective analysis of the risk of hemorrhage associated with moderate and severe thrombocytopenia of 173 patients with systemic lupus erythematosus. Medicine (Baltimore) . 2018;97:e11356. DOI: 10.1097/MD.0000000000011356. Xiao J, Li J, Chen Y , et al. The roles of CD4 + T cell and its activating transcription factor STAT4 /6 in immune thrombocytopenic purpura[J]. Guangdong Medicine,2017,38(21):3257-3260.DOI:10.13820/j.cnki.gdyx.20171113.003.（in Chinese） Lao Y,Yuan Q,Wang Y,et al. Bonemarrow morphological analysis of active systemic lupus erythematosus[J]. Laboratory Medicine and Clinical Practice, 2019,16(12):1636-1639.(in Chinese) Kuwana M, Okazaki Y, Kajihara M, Kaburaki J, Miyazaki H, Kawakami Y, Ikeda Y. Autoantibody to c-Mpl (thrombopoietin receptor) in systemic lupus erythematosus: relationship to thrombocytopenia with megakaryocytic hypoplasia. Arthritis Rheum . 2002;46:2148-2159. DOI: 10.1002/art.10420. Shiozaki H, Miyawaki S, Kuwaki T, Hagiwara T, Kato T, Miyazaki H. Autoantibodies neutralizing thrombopoietin in a patient with amegakaryocytic thrombocytopenic purpura. Blood . 2000;95:2187-2188. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. Blood Adv . 2020;4:252. DOI: 10.1182/bloodadvances.2019001380. Xiao Q, Lin B, Wang H, Zhan W, Chen P. The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis. Front Med (Lausanne) . 2021;8:656792. DOI: 10.3389/fmed.2021.656792. Mayer B, Depré F, Ringel F, Salama A. New aspects on the efficacy of high-dose intravenous immunoglobulins in patients with autoimmune thrombocytopenia. Vox Sang . 2017;112:64-69. DOI: 10.1111/vox.12467. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4874931","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":342465115,"identity":"cf606b39-04c0-4291-af1d-f3a9ad05c84a","order_by":0,"name":"Yuanhong peng","email":"","orcid":"","institution":"Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Yuanhong","middleName":"","lastName":"peng","suffix":""},{"id":342465116,"identity":"55905ed4-a54e-4285-9725-6b4129ac9926","order_by":1,"name":"Jirong Cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBAC+/bmgw8SKtjq+9kbiNRiwHMs2eDBGT7GmT0HiNUikaMm+bBNjnHDjQQitZgz5DAbJLCZMTPcfLzxBkONTTRBLZYNZ4F+4UljY5ydVmzBcCwtt4GgnoN9yQYJEsd4mKVzzCQYGw4ToeUwj5lEgsF/CTbJM0RqMTgG0pLAZsAjwUOkFskeNqDDDrAlSPAA/ZJAjF/45R8ffPjzH1uC/fHDG298qLEhwi/IjpRIIEU5RAupOkbBKBgFo2BkAAD4FEA3aONflQAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":true,"prefix":"","firstName":"Jirong","middleName":"","lastName":"Cheng","suffix":""},{"id":342465117,"identity":"4b52ce8d-6fab-4d5a-89a3-ad35b6b83151","order_by":2,"name":"Di Ma","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Di","middleName":"","lastName":"Ma","suffix":""},{"id":342465118,"identity":"ae0634b3-621c-442f-82bd-4ea8e8ccd4e2","order_by":3,"name":"Miao He","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Miao","middleName":"","lastName":"He","suffix":""},{"id":342465119,"identity":"329916ca-1ff1-426f-a83b-bc79333e8f98","order_by":4,"name":"Xing Li","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xing","middleName":"","lastName":"Li","suffix":""},{"id":342465120,"identity":"b27a24c9-b2f1-4961-8b40-7d28ffe7e3e6","order_by":5,"name":"Qian Wu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Wu","suffix":""},{"id":342465121,"identity":"05f685d1-67a0-4f57-8d3e-139f09b14dff","order_by":6,"name":"Qiurong Wu","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Qiurong","middleName":"","lastName":"Wu","suffix":""},{"id":342465122,"identity":"15977631-9277-4886-a487-0472653f5f25","order_by":7,"name":"Guohua Yuan","email":"","orcid":"","institution":"Affiliated Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Guohua","middleName":"","lastName":"Yuan","suffix":""}],"badges":[],"createdAt":"2024-08-07 12:59:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4874931/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4874931/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68742061,"identity":"81e36412-63c2-4a30-a98b-f43ffc399b46","added_by":"auto","created_at":"2024-11-11 14:32:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":638623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4874931/v1/44e91081-0e71-4035-979b-83584b76f898.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics of systemic lupus erythematosus complicated with thrombocytopenia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSystemic lupus erythematosus (SLE) is an autoimmune disease characterized by immune\u0026nbsp;system disorders that\u0026nbsp;can\u0026nbsp;affect\u0026nbsp;multiple organs.\u0026nbsp;\u003csup\u003e1, 2\u003c/sup\u003e Thrombocytopenia (TP) is one of the manifestations of hematological\u0026nbsp;involvement\u0026nbsp;closely related to other\u0026nbsp;systemic\u0026nbsp;damage, disease activity, and prognosis of\u0026nbsp;SLE\u0026nbsp;\u003csup\u003e3-5\u003c/sup\u003e.\u0026nbsp;With\u0026nbsp;advancements in\u0026nbsp;clinical diagnosis and treatment, most patients respond well to\u0026nbsp;treatment. However,\u0026nbsp;some patients\u0026nbsp;still exhibit a\u0026nbsp;poor response to\u0026nbsp;treatment, with\u0026nbsp;TP\u0026nbsp;persisting\u0026nbsp;or\u0026nbsp;recurring\u003csup\u003e6\u003c/sup\u003e. Through a retrospective study, we analyzed the clinical data of SLE patients with TP and compared them with those of SLE patients without TP to elucidate the clinical characteristics of SLE patients with TP.\u003c/p\u003e"},{"header":"Methods ","content":"\u003cp\u003e\u003cstrong\u003eClinical data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1544 inpatients with\u0026nbsp;SLE\u0026nbsp;diagnosed by the Department of Rheumatology and\u0026nbsp;Immunology at the\u0026nbsp;affiliated Hospital of North Sichuan Medical College from December 2019 to December 2023 were collected.\u0026nbsp;Other diseases that could lead to\u0026nbsp;TP, such as\u0026nbsp;primary hematological diseases, drugs, pregnancy, and severe infection, were excluded.\u0026nbsp;107 patients with SLE related thrombocytopenia were included in this study.\u0026nbsp;In the control group, Using a random number table method with a ratio of 1:2, 107 SLE inpatients without ITP who complained of rash and joint pain during the same period were selected as the non ITP group.\u0026nbsp;The diagnosis of\u0026nbsp;SLE\u0026nbsp;was\u0026nbsp;made according to\u0026nbsp;the revised\u0026nbsp;SLE classification\u0026nbsp;criteria established\u0026nbsp;by the American\u0026nbsp;College of Rheumatology\u0026nbsp;in 1997.\u0026nbsp;TP\u0026nbsp;is defined as the occurrence\u0026nbsp;of a platelet count \u0026lt; 100x10^9/L\u0026nbsp;two or more times\u0026nbsp;during\u0026nbsp;the course of the\u0026nbsp;disease, excluding\u0026nbsp;other\u0026nbsp;conditions\u0026nbsp;that can cause\u0026nbsp;TP,\u0026nbsp;including primary hematological diseases, drugs, and severe infections.\u003csup\u003e7\u003c/sup\u003eAccording to platelet count, the patients were divided into two groups: severe\u0026nbsp;TP:\u0026nbsp;PLT \u0026le; 20 \u0026times;\u0026nbsp;10^9/L,\u0026nbsp;and mild to moderate\u0026nbsp;TP\u0026nbsp;\u0026gt; 20 \u0026times; 10^9/L.\u0026nbsp;They were classified based on the degree of bone marrow hyperplasia: Active bone marrow hyperplasia showed a normal or increased number of megakaryocytes (MK) without maturation disorders, while myelodysplasia presented rare or absent MK, or maturation disorders. Refer to the Chinese guidelines for the diagnosis and treatment of Adult Primary Immune Thrombocytopenia (2020 Edition)\u0026nbsp;\u003csup\u003e8\u003c/sup\u003eformulated by the Thrombosis and Hemostasis Group of the Chinese Medical Association.\u0026nbsp;Complete response is defined as a platelet count of \u0026ge; 100 \u0026times;\u0026nbsp;10^9 / L\u0026nbsp;after treatment without bleeding.\u0026nbsp;Effective treatment is indicated by a platelet count of \u0026ge; 30 \u0026times;\u0026nbsp;10^9 / L\u0026nbsp;after treatment, at least\u0026nbsp;2\u0026nbsp;times higher than the basal platelet count, and\u0026nbsp;absence of\u0026nbsp;bleeding.\u0026nbsp;Ineffective treatment is defined as a platelet count of less than 30 \u0026times; 10^9/L after treatment, an increase in platelet count of less than 2 times the baseline value, or the presence of bleeding. Recurrence: After effective treatment, the platelet count decreased to less than 30 \u0026times; 10^9 / L, or less than 2 times the baseline value, or bleeding symptoms appeared. This study was approved by the Ethics Committee of the affiliated hospital of North Sichuan Medical College.\u0026nbsp;The informed consent of all participants was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNormal distribution data is described using mean \u0026plusmn; standard deviation, while non normal distribution data is described using median (P25, P75). For data with normal distribution and homogeneous variance, independent sample t-test is used for comparison between two groups, and one-way ANOVA is used for comparison between multiple groups.\u0026nbsp;Further multiple comparisons will be conducted using LSD or SNK tests; For non normally distributed data, Mann Whitney U test is used for comparison between two sample groups, and Kruskal Wallace test is used for analysis of differences between multiple sample groups.The comparison between categorical variables is conducted using chi square test.\u0026nbsp;Variables with a significance level below 0.2 in univariate analysis were included in multivariate logistic regression analysis (using the forward selection method) to identify factors independently associated with TP. All data analyses were performed using SPSS version 27.0. For all statistical analyses, differences were considered statistically significant when the two-sided \u003cem\u003ep\u003c/em\u003e-value was below 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eComparisons of clinical data\u0026nbsp;between\u0026nbsp;the TP and\u0026nbsp;non-TP\u0026nbsp;groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 107 cases in the TP group and 107 cases in the non-TP group.\u0026nbsp;There was no significant difference in sex, course of disease, and age between the two groups (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05),\u0026nbsp;indicating\u0026nbsp;that the baseline of the two groups was consistent and could be compared.\u0026nbsp;Compared with the clinical data of the two groups, leukopenia, anemia, lupus nephritis, and\u0026nbsp;hyper-IgG significantly increased\u0026nbsp;in the TP\u0026nbsp;group,\u0026nbsp;while anti-u1-RNP antibody and anti-SSA\u0026nbsp;antibody significantly decreased\u0026nbsp;in the TP group\u0026nbsp;(\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05, see\u0026nbsp;Table 1).\u0026nbsp;In the TP group, the SLEDAI score was higher, the anticardiolipin antibody IgM titer was higher, the absolute values of hemoglobin, white blood\u0026nbsp;cells (WBC),\u0026nbsp;lymphocytes, and glomerular filtration rate were lower, and urea and bilirubin were higher, with statistical differences between the two groups\u0026nbsp;(\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, see Table 2).\u003c/p\u003e\n\u003cp\u003eTable 1\u0026nbsp;\u0026nbsp;presents the baseline\u0026nbsp;characteristics of the TP and non-TP\u0026nbsp;groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003eTP group\u003c/p\u003e\n \u003cp\u003en（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003eNon-TP\u0026nbsp;group\u003c/p\u003e\n \u003cp\u003en（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eClinical manifestations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eLupus nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e47（43.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e24（22.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e11.15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eSerous cavity effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e11（10.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e9（8.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.221\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eMesenteric vasculitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e1（0.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e3（2.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eNeuropsychiatric lupus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e0（0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e3（2.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eRash\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e21（19.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e25（23.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.443\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003ealopecia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e5（4.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e9（8.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eArthritis/arthralgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e17（15.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e16（15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.036\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eBiological features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eLeukopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e29（27.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e13(12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e7.584\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e46(43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e23(21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e11.315\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eImmunological features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-u1-RNP antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e41(38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e57(53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e4.819\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-Sm antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e14(13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e23(21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e2.647\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eanti-nucleosome antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e27(25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e34（31.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e1.124\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-SSA antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e48（44.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e66（61.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e6.082\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-SSB antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e17（15.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e18（16.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.034\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-ribosomal P protein antibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e19（17.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e24（22.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.728\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eANCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e22（20.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e17（15.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.784\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnticardiolipin antibody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e31(29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e31(29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-\u0026beta;\u003csub\u003e2\u003c/sub\u003eGPⅠantibody positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e19(17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e12(11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e1.848\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eHypocomplementemia (C3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e89(83.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e84(78.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.754\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eHypocomplementemia (C4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e73(68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e69(64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.335\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eElevated IgA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e46(43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e43(40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e0.173\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eElevated IgG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e16（15.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e7（6.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e3.946\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.31464737793852%\" valign=\"top\"\u003e\n \u003cp\u003eElevated IgM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.732368896925859%\" valign=\"top\"\u003e\n \u003cp\u003e1（0.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.179023508137433%\" valign=\"top\"\u003e\n \u003cp\u003e3(2.8%)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.5623869801085%\" valign=\"top\"\u003e\n \u003cp\u003e1.019\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.211573236889693%\" valign=\"top\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Chi-square test; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eCorrection Chi-square test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;Comparison of laboratory\u0026nbsp;indices between\u0026nbsp;TP\u0026nbsp;combination and\u0026nbsp;non-TP groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003eTP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eNon-TP group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026nbsp;\u003c/em\u003e/ \u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eSLEDAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e6(2,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e4(1,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e2.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eESR(mm/h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e23(11.5,49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e27(16,50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-1.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eAnti \u0026beta;2-GP\u0026Iota; antibody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e30.55(21.07,57.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e32.27(28,73.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eaCL IgM(RU/ml)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e32.42(26.75,48.55)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e26.33(22.23,31.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-2.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eHB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e103.68\u0026plusmn;18.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e112.36\u0026plusmn;18.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-4.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eWBC(10E9/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e5.06(3.62,7.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e5.4(4.12,7.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eLym(10E9/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e0.77(0.55,1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e1.05(0.67,1.497)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-2.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eeGFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e92.8(56.85,123.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e104.45(65.65,131.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-1.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eUrea nitrogen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e6.4(4.54,9.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e5.23(3.69,6.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-2.572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eIndirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e7.5(4.8,11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e6(5.0,7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-2.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e4.2(3,6.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e2.4(1.4,3.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-4.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eAdenosine deaminase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.943661971830984%\" valign=\"top\"\u003e\n \u003cp\u003e19(13.75,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.774647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e15(11.77,21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091549295774648%\" valign=\"top\"\u003e\n \u003cp\u003e-3.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.915492957746478%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSLEDAI:\u0026nbsp;Systemic Lupus Erythematosus Disease Activity Index; ESR: erythrocyte sedimentation rate;\u0026nbsp;HB: hemoglobin;\u0026nbsp;Lym: Absolute lymphocyte count; WBC: white blood cells; eGFR: estimated glomerular filtration rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of\u0026nbsp;factors associated with\u0026nbsp;TP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the univariate analysis,\u0026nbsp;variables\u0026nbsp;showing\u0026nbsp;statistically significant differences were\u0026nbsp;selected\u0026nbsp;as independent variables,\u0026nbsp;while\u0026nbsp;the change in\u0026nbsp;PLT\u0026nbsp;count was\u0026nbsp;designated\u0026nbsp;as the dependent variable for binary logistic regression analysis.\u0026nbsp;The results showed that leukopenia, anemia, and lupus nephritis were independent risk factors for\u0026nbsp;TP\u0026nbsp;(\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05, Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3\u0026nbsp;\u0026nbsp;Screening independently associated factors of TP by multivariate logistic regression analysis\u0026nbsp;using the forward method in SLE.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eLeukopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e1.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e3.449(1.517~7.842)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e2.706(1.363~5.374)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eNephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e-0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e2.483(1.236~4.989)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-RNP antibody\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e-1.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e0.345(0.182~0.655)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-SSA antibody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e0.998(0.997~1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eSLEDAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.485915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.852112676056338%\" valign=\"top\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.64788732394366%\" valign=\"top\"\u003e\n \u003cp\u003e1.009(0.956~1.066)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSLEDAI:\u0026nbsp;Systemic Lupus Erythematosus Disease Activity Index; B: coefficient value; SE: standard error; \u0026nbsp;95% CI: 95% confidence interval; OR: odds ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntra-group analysis of the TP group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrouped according to platelet count\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 67 patients with mild and moderate\u0026nbsp;TP,\u0026nbsp;accounting for 62.6%, and 40 patients with severe\u0026nbsp;TP,\u0026nbsp;accounting for 37.3%.\u0026nbsp;There were 10 males (9.3%) and 97 females (90.6%).\u0026nbsp;The male-to-female ratio was 1:9.7, which was similar to the male-to-female ratio of\u0026nbsp;SLE\u0026nbsp;in the Chinese mainland area\u0026nbsp;(1:10).\u003csup\u003e9, 10\u003c/sup\u003e There were 48 cases of hemorrhage, including 31 severe cases of TP and 17 mild to moderate cases of TP. There were no significant differences in sex, age, course of SLE, course of TP, clinical manifestations (rash, splenomegaly, fever, arthralgia, alopecia, ulcer, lupus nephritis, etc.), and laboratory examinations (ESR, CRP, HB, immunoglobulin, complement, etc.) between the severe TP group and the mild to moderate TP group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of the results of bone marrow puncture in the TP group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 107 patients, 67 underwent bone marrow smears and pathological examinations.\u0026nbsp;In the mild and moderate TP group, bone marrow examination was performed in 33\u0026nbsp;cases. Bone\u0026nbsp;marrow hyperplasia decreased in 3 cases (9%),\u0026nbsp;while it remained\u0026nbsp;active in 30 cases (90.9%).\u0026nbsp;In the severe group, bone marrow examination was performed in 34\u0026nbsp;cases. Bone\u0026nbsp;marrow hyperplasia decreased in 0 cases (0%),\u0026nbsp;while\u0026nbsp;active bone marrow\u0026nbsp;hyperplasia was observed\u0026nbsp;in all\u0026nbsp;34 cases (100%).\u0026nbsp;There was no significant difference in the degree of bone marrow hyperplasia between the two groups (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). The bone marrow MK value for the mild and moderate group was 19.5 (8, 41.25), while the bone marrow MK value for the severe group was 55 (13, 142). There was a significant difference in bone marrow MK between the two groups (\u003cem\u003eP\u003c/em\u003e = 0.007). According to the comparison of the degree of maturation disorder of bone marrow MK between the two groups, the average proportion of all types of MK in the total MK of bone marrow smears in the two groups was represented as the median. Immature and granular MK were dominant in both groups, but the production of platelet MK in the mild to moderate TP group was significantly higher than in the severe TP group (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4\u0026nbsp;Comparison of the\u0026nbsp;Degree\u0026nbsp;of\u0026nbsp;Maturation Disorders\u0026nbsp;of\u0026nbsp;Bone Marrow Megakaryocytes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.448154657293498%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.114235500878735%\" valign=\"top\"\u003e\n \u003cp\u003epro-MK\u0026nbsp;（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.210896309314588%\" valign=\"top\"\u003e\n \u003cp\u003eGranular-MK（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" valign=\"top\"\u003e\n \u003cp\u003ePlate producing-MK（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.0597539543058%\" valign=\"top\"\u003e\n \u003cp\u003eNaked-MK（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eMild/Moderate TP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.448154657293498%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.114235500878735%\" valign=\"top\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.210896309314588%\" valign=\"top\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" valign=\"top\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.0597539543058%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eSevere TP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.448154657293498%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.114235500878735%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.210896309314588%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.0597539543058%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.448154657293498%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.114235500878735%\" valign=\"top\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.210896309314588%\" valign=\"top\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.0597539543058%\" valign=\"top\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMK:\u0026nbsp;megakaryocytes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation\u0026nbsp;Analysis\u0026nbsp;of\u0026nbsp;Platelet Counts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the results of bivariate correlation analysis between platelet count and clinical data (Table 5), platelet count was negatively correlated with the absolute value of\u0026nbsp;neutrophils\u0026nbsp;and complement C3 at the lowest platelet count, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). There was no significant correlation found with age, minimum platelet count, white blood cell count, lymphocyte count, hemoglobin, ESR, anti-ds-DNA antibody, complement C4, SLEDAI, cardiolipin-IgM, and immunoglobulin levels.\u003c/p\u003e\n\u003cp\u003eTable 5 \u0026nbsp;Correlation between Platelet Count and Clinical Data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.31305903398926%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePlatelet count\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eNeu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eC3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eC4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eLym\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eESR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e-0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-dsDNA antibody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eSLEDAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.686940966010734%\" valign=\"top\"\u003e\n \u003cp\u003eaCL IgM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.924865831842574%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.38819320214669%\" valign=\"top\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNeu: Absolute\u0026nbsp;value of\u0026nbsp;neutrophils; C3: Complement C3; WBC: white\u0026nbsp;blood\u0026nbsp;cells; Lym: Absolute\u0026nbsp;value of\u0026nbsp;lymphocytes; Hb: Hemoglobin; ESR: Erythrocyte\u0026nbsp;sedimentation\u0026nbsp;rate; C4: Complement C4; SLEDAI: Systemic\u0026nbsp;Lupus Erythematosus Disease Activity\u0026nbsp;Index; aCL\u0026nbsp;IgM: Anticardiolipin antibody IgM\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment differences and treatment responses in\u0026nbsp;various\u0026nbsp;groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;variances\u0026nbsp;and\u0026nbsp;reactions\u0026nbsp;among\u0026nbsp;various\u0026nbsp;groups are\u0026nbsp;illustrated\u0026nbsp;in Table 6.\u0026nbsp;The results showed that IVIG, high-dose glucocorticoids, and tacrolimus were used more frequently in the severe TP group (5 cases), mild to moderate TP group (2 cases), and Mycophenolate\u0026nbsp;mofetil (MMF)\u0026nbsp;mild to moderate TP group.\u0026nbsp;The effective rate of patients with severe TP was significantly lower than that of mild to moderate TP (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). However, there was no significant difference in the complete remission rate and inefficiency (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). The recurrence rate was higher in the severe TP group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 6\u0026nbsp;\u0026nbsp;Comparison of Therapeutic\u0026nbsp;Drugs\u0026nbsp;and Therapeutic\u0026nbsp;Responses\u0026nbsp;in\u0026nbsp;Different Groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"569\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003esevere TP\u0026nbsp;\u0026nbsp;n（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003emild to moderate TP\u0026nbsp;n（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eGC pulse therapy（500mg/d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e5（12.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e2（3.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eA large dose of\u0026nbsp;GC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e25（63.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e26（39.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.016\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eImmunosuppressant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eHCQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e27（65.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e50（75.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.268\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eMMF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e6（14.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e23（34.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.022\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eIVIG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e20（50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e10（7.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eTacrolimus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e13（31.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e8（12.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eCyclosporin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e10（24.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e10（15.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.233\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eTelitacicept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e5（12.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e2（3.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eBelimumab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e3（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e3（4.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.862\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eCTX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e1（2.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e3（4.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.577\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eLEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e0（0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e2（3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.523\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eTherapeutic response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eComplete remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e24（58.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e31（47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.244\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eEffective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e8（19.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e26（39.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.032\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eInefficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e9（22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e9（13.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.264\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.834797891036906%\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.41652021089631%\" valign=\"top\"\u003e\n \u003cp\u003e11（27.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.93145869947276%\" valign=\"top\"\u003e\n \u003cp\u003e5（7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.817223198594025%\" valign=\"top\"\u003e\n \u003cp\u003e0.005\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Chi-square test; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eCorrected Chi-square test; GC: Glucocorticoids; HCQ: Hydroxychloroquine; MMF: Mycophenolate mofetil; IVIG: intravenous immunoglobulin; CTX: cyclophosphamide; LEF: Leflunomide\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of TP in patients with SLE was 10~40 %.\u003csup\u003e11, 12\u003c/sup\u003e In 5~16% of SLE patients, it may be the first manifestation.\u003csup\u003e13\u003c/sup\u003eThe incidence rate of TP in this study was 7.8%, lower than the reported incidence rate of 21.5% by the Chinese SLE\u0026nbsp;Research Collaboration Group.\u003csup\u003e14\u003c/sup\u003eForeign literature\u003csup\u003e15\u003c/sup\u003ehas pointed out that TP can affect 7% to 30% of patients with SLE, about half of whom have TP at the beginning of diagnosis.\u0026nbsp;In this study, 56 patients had TP at the beginning\u0026nbsp;of the\u0026nbsp;diagnosis, with an\u0026nbsp;incidence rate\u0026nbsp;of 52.3%.\u0026nbsp;It can be seen that the incidence of\u0026nbsp;TP\u0026nbsp;is higher in untreated patients with primary\u0026nbsp;SLE.\u0026nbsp;The manifestations of TP are\u0026nbsp;diverse, ranging from chronic and asymptomatic to acute\u0026nbsp;or severe.\u0026nbsp;Severe TP accounts for about\u0026nbsp;3%~20% prevalence of TP\u0026nbsp;is often\u0026nbsp;linked\u0026nbsp;to the long-term\u0026nbsp;progression\u0026nbsp;of\u0026nbsp;SLE.\u003csup\u003e16\u003c/sup\u003eSevere\u0026nbsp;TP\u0026nbsp;serves as\u0026nbsp;a\u0026nbsp;negative\u0026nbsp;prognostic\u0026nbsp;indicator for\u0026nbsp;SLE and is\u0026nbsp;correlated\u0026nbsp;with high\u0026nbsp;mortality rates.\u003csup\u003e17\u003c/sup\u003eTherefore,\u0026nbsp;TP\u0026nbsp;stands out as a significant\u0026nbsp;prognostic\u0026nbsp;factor for\u0026nbsp;SLE,\u0026nbsp;warranting\u0026nbsp;clinical attention.\u0026nbsp;Clinically,\u0026nbsp;patients with TP\u0026nbsp;are usually accompanied\u0026nbsp;by damage to\u0026nbsp;other\u0026nbsp;systems\u0026nbsp;due to disease activity.\u0026nbsp;In this study, it was found that the risk of lupus nephritis in the TP group was higher than that in the non-TP group, which was consistent\u0026nbsp;with findings from\u0026nbsp;other clinical\u0026nbsp;studies.\u003csup\u003e14, 18\u003c/sup\u003eThe specific autoantibody of\u0026nbsp;SLE\u0026nbsp;is\u0026nbsp;associated with\u0026nbsp;its clinical manifestations, which is\u0026nbsp;crucial\u0026nbsp;for the diagnosis and prediction of\u0026nbsp;organ\u0026nbsp;damage.\u0026nbsp;Related studies have confirmed that anti-dsDNA antibody, anti-Sm antibody, anti-u1-RNP antibody, and anti-rRNP antibody are\u0026nbsp;associated with\u0026nbsp;TP\u003csup\u003e14, 19, 20\u003c/sup\u003eIn\u0026nbsp;this study, univariate and multivariate\u0026nbsp;analyses revealed\u0026nbsp;that the incidence of anti-u1-RNP antibody and anti-SSA antibody\u0026nbsp;in the\u0026nbsp;TP group was lower than that\u0026nbsp;in\u0026nbsp;the\u0026nbsp;non-TP group. Gonz\u0026aacute;lez-Naranjo LA\u003csup\u003e21\u003c/sup\u003efound\u0026nbsp;a correlation between anti-SSA antibodies and hematological damage, while other antibodies did not\u0026nbsp;show\u0026nbsp;a correlation with TP.\u0026nbsp;Many\u0026nbsp;studies conducted\u0026nbsp;at home and abroad have confirmed the correlation between antiphospholipid antibodies and\u0026nbsp;TP.\u003csup\u003e19, 22\u003c/sup\u003eThe\u0026nbsp;production of anticardiolipin antibodies (aCL)\u0026nbsp;is identified as\u0026nbsp;one of the\u0026nbsp;primary\u0026nbsp;causes of platelet\u0026nbsp;destruction.\u003csup\u003e23-25\u003c/sup\u003e In this study, 94 patients in the TP group and 82 patients in the control group\u0026nbsp;exhibited complete\u0026nbsp;antiphospholipid antibody profiles.\u0026nbsp;In both groups, 31\u0026nbsp;patients\u0026nbsp;tested\u0026nbsp;positive for anticardiolipin\u0026nbsp;antibodies, with\u0026nbsp;IgM\u0026nbsp;being\u0026nbsp;the most common\u0026nbsp;type\u0026nbsp;in both groups.\u0026nbsp;The IgM titers of cardiolipin antibodies in the TP group and the non-TP group were\u0026nbsp;32.42 (26.75, 48.55)\u0026nbsp;and 26.33\u0026nbsp;(22.23, 31.26),\u0026nbsp;respectively.\u0026nbsp;There was a significant difference between the two groups. It can be seen that although there was no significant difference in the detection rate of antiphospholipid antibodies between the two groups, the IgM titer of cardiolipin antibodies was higher in the TP group.\u0026nbsp;Thus, we further\u0026nbsp;utilized\u0026nbsp;univariate analysis to\u0026nbsp;examine\u0026nbsp;the correlation between antiphospholipid antibody titer and platelet count, but\u0026nbsp;no significant\u0026nbsp;correlation was\u0026nbsp;observed\u0026nbsp;between them (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). 94 patients in the TP group were categorized into positive and negative groups depending on the presence of ACLA, with total effective rates of 79.6% and 81.4%, respectively. There was no significant difference between the two groups (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe SLEDAI scores of patients in the TP group were higher than those in the non-TP group, which is consistent with relevant reports both domestically and internationally.\u003csup\u003e14, 26\u003c/sup\u003eIndicating that TP is a reliable factor\u0026nbsp;reflecting\u0026nbsp;the activity of SLE disease.\u003csup\u003e27, 28\u003c/sup\u003e The increase in autoantibodies during the active phase leads to increased platelet\u0026nbsp;destruction. Simultaneously,\u0026nbsp;it may be\u0026nbsp;associated with\u0026nbsp;low bone marrow proliferation and excessive cellular immunity.\u0026nbsp;Patients\u0026nbsp;with the\u0026nbsp;initial onset of\u0026nbsp;TP\u0026nbsp;have higher disease activity and require active monitoring\u0026nbsp;for damage to\u0026nbsp;other\u0026nbsp;systems\u0026nbsp;and early clinical intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn\u0026nbsp;SLE\u0026nbsp;patients with\u0026nbsp;TP,\u0026nbsp;most of the bone marrow hyperplasia is active or hyperplastic, and\u0026nbsp;MK is\u0026nbsp;normal or increased to produce excessive\u0026nbsp;platelets. In contrast,\u0026nbsp;in the bone marrow images of patients with hypoplasia, MK is rare or absent, often accompanied by maturation\u0026nbsp;disorders.\u003csup\u003e29, 30\u003c/sup\u003ewith high disease activity there is premature apoptosis of MK a step ahead of platelet production, hence they see less platelet making MK in the severe TP group. Thrombopoietin is not the only explanation for TP in SLE.\u0026nbsp;However, the degree of maturation disorder in the severe TP group was higher than that in the mild and moderate group. According to the literature.\u003csup\u003e31\u003c/sup\u003eIt\u0026nbsp;is reported that anti-thrombopoietin receptor antibodies can be detected in the sera of patients with\u0026nbsp;SLE\u0026nbsp;complicated\u0026nbsp;by\u0026nbsp;reduced platelet counts.\u0026nbsp;This antibody blocks the differentiation of hematopoietic stem cells into\u0026nbsp;MK\u0026nbsp;induced by thrombopoietin (TPO), thus inhibiting the production of\u0026nbsp;MK\u0026nbsp;in SLE patients at the level of\u0026nbsp;MK\u0026nbsp;precursor cells.\u0026nbsp;Hiroko et al.\u0026nbsp;\u003csup\u003e32\u003c/sup\u003edetected\u0026nbsp;anti-thrombopoietin antibodies in the sera of patients with\u0026nbsp;SLE\u0026nbsp;complicated\u0026nbsp;by platelet (PLT) reduction. These antibodies\u0026nbsp;neutralized TPO and decreased\u0026nbsp;its levels, leading to a significant reduction in megakaryocyte (MK) production.\u003c/p\u003e\n\u003cp\u003eTP is one of the common complications of SLE. Glucocorticoids, intravenous immunoglobulin, danazol, and immunosuppressants such as cyclophosphamide and splenectomy can be used to treat TP. However, glucocorticoid therapy is still a first-line treatment regimen.\u003csup\u003e33\u003c/sup\u003eIt has definite therapeutic effects on active SLE and TP,\u0026nbsp;mainly by inhibiting the production of macrophage Fc receptors.\u0026nbsp;Inhibition of platelet antibody production and binding\u0026nbsp;to the\u0026nbsp;platelet membrane reduces\u0026nbsp;their\u0026nbsp;destruction, and the dosage\u0026nbsp;for\u0026nbsp;clinical application varies greatly.\u0026nbsp;For the selection of\u0026nbsp;glucocorticoid\u0026nbsp;types, a recent meta-analysis showed that the total effective rate of dexamethasone was the same as that of\u0026nbsp;prednisone. Moreover,\u0026nbsp;the sustained effective rate of dexamethasone was higher after 12 months without changing the incidence of adverse events\u0026nbsp;(relative risk 1.34).\u003csup\u003e34\u003c/sup\u003eGC\u0026nbsp;therapy for TP\u0026nbsp;typically takes\u0026nbsp;effect within 2 weeks and\u0026nbsp;reaches\u0026nbsp;a relative peak at 6-8 weeks (63.4%).\u0026nbsp;Patients\u0026nbsp;with a high degree of bone marrow hyperplasia\u0026nbsp;experienced\u0026nbsp;better\u0026nbsp;treatment outcomes.\u0026nbsp;Long-term use of high-dose\u0026nbsp;GC\u0026nbsp;should be avoided in clinical treatment.\u0026nbsp;Platelet levels below 20 \u0026times;\u0026nbsp;10^9/L\u0026nbsp;should be actively treated, and those above 50 \u0026times;\u0026nbsp;10^9/L\u0026nbsp;should be followed up.\u0026nbsp;In this study, 18 patients did not respond to\u0026nbsp;treatment due to low\u0026nbsp;bone marrow\u0026nbsp;proliferation,\u0026nbsp;rare or\u0026nbsp;absent MK,\u0026nbsp;or maturation disorder,\u0026nbsp;indicating\u0026nbsp;refractory\u0026nbsp;TP.\u0026nbsp;In\u0026nbsp;general, controlling\u0026nbsp;glucocorticoids in such patients\u0026nbsp;is challenging, and they often succumb\u0026nbsp;to bleeding.\u0026nbsp;Lidan Zhao\u003csup\u003e27\u003c/sup\u003efound\u0026nbsp;that when patients were stratified according to BM-MK \u0026gt;\u0026nbsp;20/slice\u0026nbsp;and BM-MK \u0026le;\u0026nbsp;20/slice,\u0026nbsp;the SLE-TP effective rate (CR+PR) was 88% and 30%, respectively\u0026nbsp;(Figure\u0026nbsp;2).\u0026nbsp;The difference was statistically significant\u0026nbsp;(p =\u0026nbsp;0.002).\u0026nbsp;At the same time, the study conducted a logistic stepwise regression analysis and\u0026nbsp;demonstrated\u0026nbsp;that patients\u0026nbsp;with a\u0026nbsp;BM-MK count\u0026nbsp;greater than\u0026nbsp;20\u0026nbsp;per\u0026nbsp;tablet were more likely to\u0026nbsp;exhibit a\u0026nbsp;better clinical response.High-dose gamma\u0026nbsp;globulin, vincristine,\u0026nbsp;or splenectomy should be considered for patients with poor hormone\u0026nbsp;response,\u0026nbsp;hypoplasia of bone marrow, and platelet transfusion should be used if necessary to prevent bleeding.\u0026nbsp;In this\u0026nbsp;study,\u0026nbsp;18 patients\u0026nbsp;received\u0026nbsp;intravenous immunoglobulin (IVIG)\u0026nbsp;at a dosage of 15g per day\u0026nbsp;for 3 to 5\u0026nbsp;days. This treatment led to a rapid increase in\u0026nbsp;platelet\u0026nbsp;levels, but showed limited efficacy\u0026nbsp;in the\u0026nbsp;long term.\u0026nbsp;Its effect was limited to\u0026nbsp;the short term,\u0026nbsp;\u003csup\u003e35\u003c/sup\u003ewhich\u0026nbsp;was suitable for emergency patients.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;This study is a single-center small sample retrospective study. Some patients lack clinical data, which may affect the results of inter-group comparison. It will be continuously followed up in future studies. To sum up, TP is one of the common manifestations of hematological damage in patients with SLE, which is often accompanied by anemia, leukopenia, and a high SLEDAI score. Leukopenia, anemia, and lupus nephritis are independent risk factors for TP.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eThe authors would like to thank all patients and study site personnel for participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This work was supported by the Municipal School Cooperative Research Special Project (Sichuan North Medical College) in Nanchong, Sichuan Province (No. 19SXHZ0140).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The author(s) declared no potential conflicts of\u0026nbsp;interest with\u0026nbsp;in respect\u0026nbsp;to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement\u0026nbsp;\u003c/strong\u003ePatients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003eThis study received approval from the Institutional Medical Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (2023ER180-1).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G. 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The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis. \u003cem\u003eFront Med (Lausanne)\u003c/em\u003e. 2021;8:656792. DOI: 10.3389/fmed.2021.656792.\u003c/li\u003e\n\u003cli\u003eMayer B, Depr\u0026eacute; F, Ringel F, Salama A. New aspects on the efficacy of high-dose intravenous immunoglobulins in patients with autoimmune thrombocytopenia. \u003cem\u003eVox Sang\u003c/em\u003e. 2017;112:64-69. DOI: 10.1111/vox.12467.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"lupus erythematosus, systemic, immune thrombocytopenia","lastPublishedDoi":"10.21203/rs.3.rs-4874931/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4874931/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo explore the clinical characteristics and treatment outcomes of systemic lupus erythematosus (SLE) complicated with thrombocytopenia (TP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe clinical data of SLE patients with TP were collected. These TP patients were matched with SLE patients without TP in the same period at a 1:1 ratio. Multivariate logistic regression analysis was used for comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe incidence of leukopenia, anemia, lupus nephritis, and hyper-IgG in the TP group increased significantly. Additionally, the SLEDAI score in the TP group was higher (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), while the incidence of anti-u1-RNP antibody and anti-SSA antibody was lower than that in the non-TP group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Multivariate logistic analysis revealed that leukopenia, anemia, and lupus nephritis were independent risk factors for TP (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). There were 67 patients with mild and moderate TP (PLT \u0026gt; 20×10^9/L), and 40 patients with severe TP (PLT ≤ 20×10^9/L). The number of bone marrow megakaryocytes (MK) in the mild and moderate TP group [19.5 (8, 41.25)] was lower than that in the severe TP group [55 (13, 142)] (\u003cem\u003eP\u003c/em\u003e = 0.007). Platelet MK production in the mild and moderate TP group was significantly higher than that in the severe TP group (\u003cem\u003eP\u003c/em\u003e=0.028). Intravenous immunoglobulin (IVIG), high-dose glucocorticoids, and tacrolimus were more commonly utilized in the severe TP group, whereas mycophenolate mofetil (MMF) was more frequently used in the mild and moderate TP groups (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). The effective rate of patients with severe TP was lower than that of patients with mild and moderate TP (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e TP often accompanied with anemia, leukopenia, and a high SLE Disease Activity Index (SLEDAI) score. Leukopenia, anemia, and lupus nephritis are independent risk factors for TP. Patients with severe TP tend to use high-dose glucocorticoids and IVIG, and the effective rate of treatment for mild and moderate TP is higher. The recurrence frequency of patients with severe TP after complete remission is significantly higher than that of patients with mild and moderate TP.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics of systemic lupus erythematosus complicated with thrombocytopenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-06 16:28:45","doi":"10.21203/rs.3.rs-4874931/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32bb84b6-6940-4465-b4df-fce282a8c9cf","owner":[],"postedDate":"September 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-11T14:24:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-06 16:28:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4874931","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4874931","identity":"rs-4874931","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}