神经精神性狼疮患者的临床特点

目的了解神经精神性狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)患者的临床特点,加强对该病的认识,以指导临床进行早期诊断和治疗,改善疾病预后。方法选取2011年6月—2016年6月在海南省人民医院住院的82例NPSLE患者作为病例组,同期收集本院确诊为系统性红斑狼疮(systemic lupus erythematosus,SLE)但无神经精神症状的82名住院患者作为对照组,了解NPSLE患者神经精神症状,并比较两组患者的一般情况、临床表现、实验室和免疫学检查。结果 82例NPSLE患者,男性9例,女性73例,年龄(33.2±16.7)岁,病程1年者占69.5%,病例组患者病程要短于对照组(P0.05);62.2%的NPSLE患者在SLE发病3年内出现神经精神症状,常见的症状为狼疮性头痛(20.0%)、癫痫(12.0%)、性格改变(10.5%)和焦虑(10.5%),85.4%的患者合并有其他临床表现,主要为面部红斑(68.3%)、肾脏受累(59.8%)、关节疼痛(42.7%)等,与对照组相比,NPSLE患者更易合并光感性皮疹(P0.05);两组患者血小板、血肌酐、补体C4、免疫球蛋白Ig M、抗ds-DNA抗体、抗r-RNP抗体差异有统计学意义(P0.05)。结论 NPSLE患者偏向于青年女性,常发生于SLE病程的早期阶段,大部分患者在SLE发病3年内会出现神经精神症状,且更易合并光感性皮疹,血小板、肌酐、补体C4的降低和Ig M、抗ds-DNA抗体、抗r-RNP抗体水平的升高可辅助NPSLE进行早期诊断和预测。

Clinical features of patients with neuropsychiatric systemic lupus erythematosus

Objective To strengthen the understanding of the disease about NPSLE,in order to guide the early diagnosis and treatment and improve the prognosis of the disease.Methods A total of 82 cases of NPSLE patients in Hainan Ceneral Hospital from June 2011 to June 2016 were collected as a case group,and 82 patients with SLE but no neurological symptoms in the same hospital were collected as a control group,to explore the neurological and psychiatric symptoms of NPSLE patients,and compare the general conditions,clinical manifestations,laboratory tests and immunological findings of the two groups.Results There were 9 males and 73 females in case group,the age of NPSLE patients were (33.2+ 16.7) years old,69.5％ patients had the course of disease less than 1 years,and the course of disease in case group were shorter than that in control group (P ＜ 0.05);62.2％ NPSLE patients had the neurological symptoms within 3 years after SLE,the common symptoms were lupus headache (20.0％),epilepsy (12.0％),personality change (10.5％) and anxiety (10.5％);85.4％ patients in the case group were combined with other clinical manifestations,mainly for facial erythema (68.3％),renal involvement (59.8％),and joint pain (42.7％),NPSLE were more likely to be combined with light sensitive skin rash (P ＜ 0.05) than patients in control groups;There were statistically differences in two groups of patients with PLT,Cr,C4,IgM,anti ds-DNA antibody and anti-rRNP antibody between patients in case group and control group (P ＜ 0.05).Conclusiorn Most NPSLE patients were young women,and were in the early stage of SLE.Most patients will have neuropsychiatric symptoms within three years of SLE,and more susceptible to light sensitive skin rash,the reducing of PLT,Cr,C4 and the increasing of IgM,anti ds-DNA and anti-rRNP antibody levels can provide the early diagnosis and prediction of NPSLE.