伴发视网膜病变的系统性红斑狼疮患者的临床特征  

Clinical features of systemic lupus erythematosus with retinopathy

作　　者：王育新[1] 李毓敏[3] 王新昌[2] 俞萍萍[1] 邵毓[1] 徐东[1] 吕小利[1] 

机构地区：[1]浙江中医药大学附属第二医院浙江省新华医院眼科,杭州310005 [2]浙江中医药大学附属第二医院浙江省新华医院风湿科,杭州310005 [3]浙江大学医学院附属邵逸夫医院眼科

出　　处：《中华眼底病杂志》2012年第4期368-371,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察伴发视网膜病变的系统性红斑狼疮（SLE）患者的临床特征。方法 采用临床对比研究方法。临床确诊为SLE的97例患者纳入本研究。根据眼底检查结果分为视网膜病变组（阳性组）和无视网膜病变组（阴性组）。其中，阳性组23例32只眼，阴性组74例148只眼。对比分析两组患者年龄、病程、临床表现、实验室检查结果的异同。结果 SLE患者中视网膜病变阳性率为23.7%。阳性组中17例22只眼视网膜可见不同程度的棉绒斑、出血、静脉纡曲扩张、动脉痉挛、微动脉瘤、硬性渗出，占阳性例数的73.9%；其余6例10只眼以视网膜大血管阻塞为主要表现，占阳性例数的26.1%。阳性组患者皮疹、皮肤血管炎、血红细胞沉降率（ESR）升高、补体C3下降、抗双链DNA（ds-DNA）抗体阳性的发生率较阴性组患者高，相关指标比较，差异均有统计学意义（χ2=9.206，6.987，7.824，8.581，6.599；P＜0.05）。阳性组与阴性组患者之间年龄、病程、黏膜溃疡、关节炎、发热、头痛、白细胞减少、血小板减少、蛋白尿≥＋＋＋、血尿素氮升高、肌酐升高、抗核抗体（ANA）阳性、抗Sm抗体阳性的发生率相比较，差异无统计学意义（t=0.321，0.063；χ2=0.135，0.046，0.176，0.002，0.036，0.113，0.053，0.032，0.012，0.000，0.004；P＞0.05）。结论 伴发视网膜病变的SLE患者眼底主要表现为静脉纡曲扩张、棉绒斑和视网膜大血管阻塞。皮疹、皮肤血管炎、ESR升高、补体C3下降、抗ds-DNA抗体阳性是伴发视网膜病变的SLE患者的主要临床特征。Objective To observe the clinical features of systemic lupus erythematosus （SLE） with retinopathy.Methods Ninety-seven SLE patients were enrolled in this comparative clinical study. The patients were divided into retinopathy group （positive group, 32 eyes of 23 patients） and non-retinopathy group （negative group, 148 eyes of 74 patients）. The age, course of disease, clinical features, laboratory results in these two groups were comparatively analyzed.Results The positive rate of retinopathy in all SLE patients was 23.7%. Seventeen patients （22 eyes, 73.9%） of positive group had retinal cotton-wool spot, retinal hemorrhage, tortuous retinal vein, retinal arterial spasm, microaneurysm and hard exudates. The other six patients （10 eyes, 26.1%） in this group showed retinal main vessel occlusion. The incidence rate of rash, cutaneous vasculitis, elevated erythrocyte sedimentation rate （ESR）, decreased complement C3 and positive anti double stranded-DNA （anti-ds-DNA） antibody in the positive group were higher than those in the negative group （χ2=9.206, 6.987, 7.824, 8.581, 6.599;P〈0.05）. There was no significant difference between these two groups in age, course of disease, mucosal ulcers, arthritis, fever, headache, neutropenia, thrombocytopenia, proteinuria, elevated blood urea nitrogen, increased creatinine, positive antinuclear （ANA） and anti-Sm antibodies （t=0.321, 0.063;χ2=0.135, 0.046, 0.176, 0.002, 0.036, 0.113, 0.053,0.032,0.012,0.000,0.004;P〉0.05）. Conclusions Tortuous retinal veins, retinal cotton-wool spots and retinal main vessels occlusion are the three major fundus features of SLE patient with retinopathy. Rash, cutaneous vasculitis, increased ESR, decreased complement C3 and positive anti-ds-DNA antibody are the five major systemic clinical features of SLE patient with retinopathy.

关 键 词：红斑狼疮 系统性/并发症 视网膜疾病/病因学 疾病特征 

分 类 号：R774.1[医药卫生—眼科] R593.241[医药卫生—临床医学]