混合性结缔组织病并发三叉神经病变12例  

Clinical analysis of 12 cases of mixed connective tissue disease-associated trigeminal neuropathy

作　　者：高小娟[1] 李玉慧[2] 张学武[2] 陈适[2] 刘燕鹰[2] Gao Xiaojuan;Li Yuhui;Zhang Xueivu;Chen Shi;Liu Yanying(Department of Rheumatology,Ningde Hospital,Affiliated Hospital of Fujian Medical University,Ningde 352000,China;Department of Rheumatology,People's Hospital of Peking University,Beijing 100044,China)

机构地区：[1]福建医科大学附属医院宁德市医院风湿免疫科,宁德352000 [2]北京大学人民医院风湿免疫科,北京100044

出　　处：《中华医学杂志》2020年第12期938-941,共4页National Medical Journal of China

基　　金：国家自然科学基金(81801617);国家重点研发计划(2017YFA0105802);北京大学人民医院研究与发展基金(RDY2018-01,RS2018-02,RDKP2019-02,RDE2019-02);北京大学人民医院研究与发展基金(RDH 2017-02)。

摘　　要：目的了解合并三叉神经病变(TN)的混合性结缔组织病(MCTD)的临床特征、免疫学改变及预后,提高临床医师对MCTD并发TN的认识。方法回顾性分析2008年1月至2019年10月在北京大学人民医院确诊为MCTD合并TN的12例患者临床资料。结果12例患者中男1例,女11例,年龄(40±13)岁。1例以TN首发,10例以MCTD首发,1例两者同时发病。以雷诺现象(12例)、肺部受累(11例)、关节炎(10例)、手指肿胀(9例)及肌炎(6例)为主要表现。所有患者抗核抗体(ANA)及抗U1-RNP抗体均阳性,且抗U1-RNP抗体高滴度,7例血红细胞沉降率均不同程度升高,5例肌酶升高。9例行瞬目反射试验,其中6例阳性。糖皮质激素联合免疫抑制剂或联合静脉注射人免疫球蛋白治疗原发病为主,神经系统症状改善缓慢,但无进展。结论MCTD病情活动时出现TN,伴有TN的MCTD中ANA和抗U1-RNP抗体阳性率高,瞬目反射试验对明确诊断MCTD合并TN十分重要,治疗原发病有助于控制疾病的进展。Objective The aim of present study is to analyze clinical and laboratory features of mixed connective tissue disease(MCTD)-associated trigeminal neuropathy(TN).Methods Clinical records of 12 cases of MCTD complicated with TN diagnosed in Peking University People′s Hospital from January 2008 to October 2019 were analyzed retrospectively.Results The present study included 12 cases,1 males and 11 females,average age was(40±13)years.TN was developed before the diagosis of MCTD in 1 case.TN and MCTD were occurred simutaneously in 1 case.Raynaud phenomenon(12 cases),arthritis(10cases),edema of fingers(9cases),myositis(6 cases),and pulmonary involvement(11cases)were main cinical feature of MCTD-associate TN.Antinuclear antibody(ANA)and high titer anti-U1-RNP antibody could be detected in serum of all patients.Elevated erythrocyte sedimentation rate(ESR)and creatine kinase were found in serum of 7cases and 5cases,respectively.Blink reflex tests were positive in 6 cases.Neurological symptoms improve slowly without any progress by using glucocorticoid combined immunosuppressants or intravenous gamma globulin.Conclusions TN is often associted with actived MCTD.Positive ANA and anti-U1-RNP antibody were common in MCTD-associated TN.Blink reflex test is essential to diagnose MCTD-associated TN.Intensive treatment of MCTD contributes to control the progress of TN.

关 键 词：混合性结缔组织病 三叉神经病变 雷诺现象 瞬目反射 

分 类 号：R593[医药卫生—内科学] R74[医药卫生—临床医学]