中国实用儿科杂志

中国实用儿科杂志

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儿童神经精神性狼疮14例临床特点及危险因素分析

  

  1. 中国医科大学附属第一医院儿科，辽宁  沈阳 110001
  • 出版日期:2016-10-06 发布日期:2016-10-20

Study on the clinical characteristics and risk factors of neuropsychiatric systemic lupus erythematosus in children

  1. Department of Pediatrics，the First Affiliated Hospital，China Medical University，Shenyang  110001， China
  • Online:2016-10-06 Published:2016-10-20

摘要：

目的    总结儿童神经精神性狼疮（NPSLE）的临床特点，并探讨儿童系统性红斑狼疮（SLE）并发NPSLE的相关危险因素。方法    对2005年1月至2013年8月在中国医科大学附属第一医院儿科住院的14例NPSLE患儿临床资料进行回顾性分析，同时选择同期入院的31例无NPSLE的SLE患儿作对照，对两组患儿的发病年龄、性别、临床表现、实验室检查等因素进行单因素及多因素分析。结果    NPSLE患儿的主要临床表现为头痛2例（50.0%）、偏侧型运动障碍7例（50.0%）、精神异常5例（35.7%）、癫痫样发作5例（35.7%）、不自主运动2例（14.3%）、视物不清2例（14.3%）等。13例行头颅磁共振成像（MRI）检查均有异常表现。单因素分析显示患儿口腔溃疡、血淋巴细胞减少、血小板减少、C反应蛋白（CRP）升高、抗心磷脂抗体阳性、抗中性粒细胞胞浆抗体阳性、抗u1-RNP抗体阳性、尿红细胞增多、血K+升高、血尿素氮升高、血肌酐升高为有统计学意义的危险因素；进一步行非选择性多因素回归分析结果显示抗心磷脂抗体阳性、CRP升高、血肌酐升高是发生NPSLE的独立危险因素（OR=8.296、11.170、30.415，P＜0.05）。结论    头痛、运动障碍、精神异常以及癫痫样发作是NPSLE患儿最常见的临床症状，抗心磷脂抗体阳性、CRP升高、血肌酐升高是SLE患儿发生NPSLE的危险因素。

关键词: 神经精神性狼疮, 危险因素, 系统性红斑狼疮

Abstract:

Objective    The aim of this study was to summarize the clinical features in children with neuropsychiatric systemic lupus erythematosus（NPSLE） and  to investigate  the related risk factors of  in  systemic lupus erythematosus（SLE） patients  with  NPSLE. Methods     The clinical data of 14 children with NPSLE were retrospectively analyzed. The indicators including the age， sex， clinical manifestations， laboratory tests were compared with 31 randomly selected SLE patients with  non-NPSLE manifestations by univariate and multivariate analysis. Results    The main clinical manifestations in children with NPSLE were headache（50%），lateral type motor disorder（50%），mental disorders（35.7%），epilepsy（35.7%），involuntary movement （14.29%），blurred vision（14.29%） etc. 13 patients had abnormalities in brain MRI. Univariate analysis showed that children with oral ulcers，blood lymphopenia，thrombocytopenia，elevated CRP，anticardiolipin antibodies positive，antineutrophil cytoplasmic antibody positive，anti-u1-RNP antibody positive，urine red blood cells increased，elevated serum K+ elevated，blood urea nitrogen，elevated serum creatinine were the risk factors with statistical significance.  Further non-selective multivariate regression analysis showed that only the anticardiolipin antibody positive， elevated CRP， elevated serum creatinine into the multiple regression equation， a positive correlation. Conclusion    Headache， movement disorders， mental disorders and seizures were the most common symptoms in children with NPSLE. The brain MRI is a sensitive indicator of checking NPSLE. Anticardiolipin antibody positive， elevated CRP and elevated serum creatinine were the most important risk factor for SLE children with    NPSLE.

Key words: neuropsychiatric systemic lupus erythematosus, risk factors, systemic lupus erythematosusy