新生儿红斑狼疮4例临床分析并文献复习  

Neonatal Lupus Erythematosus: Report of Four Cases and Literature Review

作　　者：徐平[1] 王威[2] 陈晓霞[3] 余德厚[2] 刘玉波[2] 何勤[2] 

机构地区：[1]贵州医科大学第二附属医院皮肤科,贵州凯里556000 [2]贵州医科大学附属医院皮肤科,贵州贵阳550000 [3]贵州医科大学附属医院新生儿科,贵州贵阳550000

出　　处：《中国皮肤性病学杂志》2017年第7期751-753,共3页The Chinese Journal of Dermatovenereology

摘　　要：目的探讨新生儿红斑狼疮(neonatal lupus erythematosus,NLE)临床特点、治疗及预后。方法回顾性分析本科诊治的4例新生儿红斑狼疮临床资料,并复习相关文献。结果男女各2例,皮损均主要位于头面及躯干,无心脏传导阻滞,仅1例心脏B超示:先天性心脏病,房间隔中心型缺损(房水平左向右分流);2例有轻度至中度贫血;1例出生后10天时出现转氨酶升高及高胆红素血症。患儿和其母亲抗核抗体(antinuclear antibody,ANA)及抗干燥综合征抗原A(SSA)抗体均阳性,3例抗干燥综合征抗原B(SSB)抗体阳性;1例患儿母亲产前诊断为干燥综合征(SS),1例母亲产后1月出现亚急性皮肤型红斑狼疮(subacute cutaneous lupus erythematosus,SCLE)皮损,另1例母亲产后2年诊断系统性红斑狼疮(systemic lupus erythematosus,SLE)。结论国内NLE患儿以一过性皮肤损害为主要临床表现,可伴有轻度肝脏和血液系统损害,而先天性心脏传导阻滞(congenital heart block,CHB)较为少见。抗Ro/SSA、抗La/SSB抗体是NLE患儿及母亲最常见的抗体。本病预后较好,但需长期随访。Objective To elucidate the clinical manifestation, treatment and prognosis of neonatal lupus erythematosus（NLE）in China. Methods All four NLE infants and their mothers were included in this study, who were hospitalized in our hospital for the last two years. Their clinical manifestations, serum autoantibodies profile, and follow-up information were analyzed, meanwhile, related literatures were reviewed. Results A total of four cases of NLE were studied（two male and two female newborn）. The skin lesions could be localized or disseminated, and the face was the most commonly affected. The limbs, trunk were also affected. No heart block was developed in four newborns, however, one newborn was diagnosed as atrial septal defect by cardiac ultrasound. There were anemia found in two cases; elevated liver transaminases and hyperbilirubinemia found in another case. Serologic investigation showed positive ANA and anti-SSA antibodies in the sera from all the four newborn and their mothers. Interestingly, there were positive anti- SSB antibodies found in three newborns. There was one mother of affected newborn who was diagnosed as Sjorgren＇s syndrome before delivery; One mother who developed classical signs of subacute cutaneous lupus erythematosus a month later; And another mother was diagnosed with systemic lupus erythematosus two years later. Conclusion The NLE cases in our study presented as transient rashes with rare congenital heart block（CHB）. Hematological abnormalities and hepatic impairments happened occasionally. Anti-SSA and/or anti-SSB were the predominant autoantibodies found in affected newborn and their mothers. It was fortunate that most babies with NLE have relatively good prognosis, but the long-term follow-up was still necessary.

关 键 词：新生儿 红斑狼疮 预后 抗Ro/SSA抗体 抗La/SSB抗体 

分 类 号：R593.24[医药卫生—内科学]