合并视网膜大血管阻塞的系统性红斑狼疮的临床观察

目的：观察系统性红斑狼疮(SLE)合并视网膜大血管阻塞的临床特点。

方法：选取2010-01/2014-01我院收治的SLE合并视网膜大血管阻塞的患者17例21眼为试验组，另选取不合并视网膜病变的SLE患者30例60眼为对照组，完善眼部和全身检查及相关化验包括各种自身免疫抗体，记录临床症状和体征。

结果：试验组13例为单眼发病，4例为双眼发病，其中视网膜中央静脉阻塞(CRVO)7眼(33%)，视网膜分支静脉阻塞(BRVO)9眼(43%)，视网膜中央动脉阻塞(CRAO)3眼(14%)，视网膜分支动脉阻塞(BRAO)1眼(5%)，CRAO合并CRVO 1眼(5%)。试验组BCVA显著差于对照组； 皮肤红斑(76%)、发热(59%)、关节炎(53%)、中枢神经系统症状(头痛及精神神经异常)(76%)、胸膜炎(41%)发生率显著高于对照组； 抗ds-DNA抗体(100%)、抗磷脂抗体(65%)阳性率显著高于对照组； 补体C3降低(82%)、血沉升高(100%)、血小板减少(65%)发生率显著高于对照组。SLEDAI评分为20.24±4.66提示疾病处于中度及重度活动期。

结论：合并视网膜大血管阻塞的SLE患者，视力受损严重，全身多系统均有不同程度受累，且均为疾病中度及重度活动期。与APA、中枢神经系统病变可能存在相关性。

Clinical observation of systemic lupus erythematosus complicated with major retinal vascular occlusion

AIM:To observe the clinical characteristics of the patients with systemic lupus erythematosus(SLE)complicated with major retinal vascular occlusion.

METHODS:Seventeen patients(21 eyes)with SLE complicated with major retinal vascular occlusion were selected as the experimental group from January 2010 to January 2014 in our hospital. Thirty cases(60 eyes)of SLE patients without retinopathy were selected as the control group. Ocular and systemic examination and related laboratory tests, including various autoimmune antibodies, were taken. Clinical symptoms and signs were recorded.

RESULTS:In the experimental group, 13 cases were uniocular, 4 cases were bilocular, in which there were central retinal vein occlusion(CRVO)in 7 eyes(33%), branch retinal vein occlusion(BRVO)in 9 eyes(43%), central retinal artery occlusion(CRAO)in 3 eyes(14%),branch retinal artery occlusion(BRAO)in 1 eye(5%),CRAO combined with CRVO in 1 eye(5%). The best corrected visual acuity(BCVA)of the experimental group was significantly worse than that of the control group. The incidence of skin erythema(76%), fever(59%), arthritis(53%), central nervous system symptoms(headache and neuropsychiatric abnormalities)(76%), pleurisy(41%)were significantly higher than those of the control group. The positive rate of anti ds-DNA antibody(100%)and antiphospholipid antibody(65%), the decrease of C3(82%), the elevation of erythrocyte sedimentation rate(100%), thrombocytopenia(65%)were significantly higher than those of the control group. The score of SLEDAI(systemic lupus erythematosus disease activity index)was 20.24±4.66 prompting SLE in moderate or severe active stage.

CONCLUSION:In SLE patients with major retinal vascular occlusion, the visual acuity was severely damaged, the multi-system was affected in varying degrees, and all of the patients were in moderate and severe activity period. There may be a correlation between retinal vascular occlusion, APA, and central nervous system disease in SLE.