系统性红斑狼疮的视网膜血管病变程度与疾病活动的相关性

目的：观察早期系统性红斑狼疮（SLE）患者出现的眼部病变特征，特别是视网膜血管病变程度与疾病活动的相关性。方法：30例无视网膜血管病变的早期SLE患者作为对照组，32例确诊为视网膜血管病变（视网膜组）的早期SLE患者为研究对象。所有SLE患者经眼科医生检查视力、裂隙灯检查、视野、光学相干断层扫描（0CT）检查、眼底照相、荧光素眼底血管造影（FFA），并根据BenEzra评分系统进行评分，同时评估各系统受累情况及临床表现、实验室检查、影像学检查等。结果：早期SLE患者视网膜血管病变可表现为程度不同的棉绒斑，血管迂曲扩张，视网膜前或视网膜下小片出血，最后可导致视网膜血管增生性改变；视网膜组与对照组比较，前者雷诺现象的发生率及抗ds-DNA抗体阳性率更高（P〈0．05），且视网膜组患者的SLE疾病活动指数（SLEDAI）与对照组比较差异有统计学意义（Z=-2．695，P=0．007）；视网膜组的BenEzra评分和SLEDAI评分呈正相关（r=0．886，P〈0．001）。结论：早期SLE患者即可发生视网膜血管病变，尤其是存在雷诺现象者；BenEzra评分对SLE患者疾病活动的早期判断和血管炎病变有一定的预测价值。

Correlative study on retinal vascular lesions on systemic lupus erythematosus and disease activity

Objective： To observe the early characteristics of systemic lupus erythematosus （SLE） patients with retinal vascular lesions and to investigate correlation between the degree of retinal vascular lesions and disease activity. Methods： The SLE patients were divided into 2 groups： experimental group （patient with retinal vasculopathy） and control group. All the patients were checked of vision, slit lamp, visualfield, OCT, fundus photograph, fundus fluorescence angiography （FFA） and then rated by the BenEzra scoring system, evaluating the relationship between ocular manifestation and lupus activity. Results： The early stage SLE patients showed different levels of retinal vascular lesion, including cotton wool spots, blood vessels expand circuity, retinal hemorrhage which may lead to proliferative retinopathy. Between two groups, patients with retinopathy have higher positive rate in Raynaud＇s phenomenon and ds-DNA （P〈0.05）. There was significant difference in the SLEDAI scoring （Z=-2.695, P=0.007）. There was positive correlation bewteen the BenEzra score and SLEDAI scores （r=- 0.836, P〈0.001）. Conclusion： Retinal vascular lesions can happen in early SLE, particularly with Raynaud＇s phenomenon; BenEzra plays important role in early judgment of desease activities and vasculitis on SLE.