儿童系统性红斑狼疮伴肺胸膜病变的临床特征分析

目的:了解儿童系统性红斑狼疮(SLE)肺胸膜病变受累的临床特征并分析其相关因素。方法:收集2001年1月至2010年12月共10年,收住在浙江大学医学院附属儿童医院初诊的非感染性SLE患儿133例的临床资料,回顾分析其肺胸膜病变的临床特征、影像学表现及相关实验室指标。结果:133例SLE患儿中并发肺胸膜病变者45例(33.83%),其中有呼吸系统表现者30例(66.67%),无呼吸系统表现者15例(33.33%);呼吸系统最常见临床症状为咳嗽咳痰(55.56%),其次为呼吸困难和胸痛(15.56%和11.11%);只有28.89%患儿肺部可闻及干和/或湿性罗音。肺胸膜病变类型以胸腔积液/胸膜炎最多(32例,71.11%),其次为支气管肺炎样改变(21例,46.67%)和肺间质病变(13例,28.89%)。与无肺胸膜病变组比较,肺胸膜病变组患儿白细胞减少、补体C3减低、抗dsDNA抗体(+)发生率更高,差异均有统计学意义(P<0.05);两组间血沉、C反应蛋白及血小板异常,免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)异常,以及抗核抗体(+)、抗SSA抗体(+)、抗SSB抗体(+)、抗Sm抗体(+)发生率的差异无统计学意义(P>0.05)。结论:儿童SLE累及肺胸膜病变发生率高,临床表现缺乏特异性,部分病例可无呼吸系统症状或体征,但白细胞减少、补体C3减低、抗dsDNA抗体(+)的SLE患儿肺胸膜病变发生率较高。建议SLE患儿常规行胸片或HRCT检查。

Clinical features of systemic lupus erythematosus with pulmonary pleural lesion in children

Objective: To investigate the clinical features of systemic lupus erythematosus(SLE) with pulmonary pleural lesion in children.Methods: One hundred and thirty three child patients with SLE admitted from 2001 to 2010 were enrolled in the study.The clinical data,chest X-ray findings and laboratory examination were retrospectively reviewed.Cases with infectious pulmonary pleural lesion were excluded.Results: According to chest X-ray findings pleural pulmonary lesions were involved in 45 out of 133 cases with SLE(33.83%);however,only 30 cases(66.67%) had positive respiratory manifestations.Respiratory features included cough and/or sputum(55.56%),dyspnea and chest pain(15.56% and 11.11%),and only 28.89% case with pleural pulmonary lesions had rales.Chest X-ray findings included pleural effusion / pleurisy(32 cases,71.11%),bronchial pneumonia(21 cases,46.67%) or interstitial pulmonary disease(13 cases,28.89%).Compared to children without pulmonary pleural lesion,children with pulmonary pleural lesion had higher incidence of leukopenia,lower C3 or antibody dsDNA(+)(all P<0.05).There was no difference in abnormality of erythrocyte sedimentation rate(ESR),CRP,IgG,IgA,IgM,thrombocytopenia,antibody ANA(+),anti-SSA(+),anti-SSB(+) or anti-Sm(+) between children with or without pulmonary pleural lesion(P>0.05).Conclusions: High incidence of pulmonary pleura lesions are present in children with SLE,however,clinical manifestations are lack of specificity or even no respiratory manifestation.Chest X-ray or HRCT scan are necessary in all cases with SLE.Children with leukopenia,lower C3 or antibody dsDNA(+) are more likely to have pulmonary pleural lesion.