原发性干燥综合征患者伴发中枢神经病变的相关风险因子分析  

Analysis of risk factors associated with central neuropathy in patients with primary Sjogren's syndrome

作　　者：袁超[1] 郑佳曼 郑丽娟 梁人戈 刘嘉怡 黄琴[2] YUAN Chao;ZHENG Jiaman;ZHENG Lijuan;LIANG Renge;LIU Jiayi;HUANG Qin(Nanfang Hospital,Southern Medical University,Department of Neurology;Nanfang Hospital,Southern Medical University,Department of Rheumatology;First Clinical Medicine College,Southern Medical University,Guangzhou 510015,China)

机构地区：[1]南方医科大学南方医院神经内科,广东广州510015 [2]南方医科大学南方医院风湿免疫科,广东广州510015 [3]南方医科大学第一临床医学院,广东广州510015

出　　处：《皮肤性病诊疗学杂志》2021年第4期245-253,共9页Journal of Diagnosis and Therapy on Dermato-venereology

基　　金：Supported by National Natural Science Foundation of China(No.82001315);the Science and Technology Planning Project of Guangzhou(No.202102020832)。

摘　　要：目的:探讨原发性干燥综合征伴发中枢神经病变(pSS-CNS)的临床特点及危险因素。方法:将2015年1月至2020年10月南方医科大学南方医院确诊的291例原发性干燥综合征(pSS)患者,分为pSS-nCNS组(246例)和pSS-CNS组(45例),收集两组患者的一般情况、临床表现、实验室检查结果等临床资料,分析两组之间的临床特点,对pSS伴发中枢神经系统病变的危险因素进行多因素Logistic回归分析,并绘制ROC曲线评估各危险因素的预测价值。结果:(1)pSS-CNS患者中以视神经脊髓炎谱病(NMOSD)为主(15例,33.3%),其余30例包括脑白质变性、中风、典型及痴呆等中枢病变;(2)pSS-CNS组疾病活动性指数评分(ESSDAI)较pSS-nCNS组高[(11.14±2.97)分比(5.39±2.06)分,P<0.01)];(3)pSS-CNS的独立危险因素分别为IgG(OR:0.890;95%CI:0.826~0.959;P=0.002)、IgM(OR:0.367;95%CI:0.182~0.739;P=0.005)、CH50(OR:0.935;95%CI:0.901~0.970;P<0.01)、PLT(OR:1.005;95%CI:1.001~1.009;P=0.010),四者曲线下面积分别为:0.890(0.826~0.959)、0.367(0.182~0.739)、0.935(0.901~0.970)、1.005(1.001~1.009),四者联合应用的曲线下面积为0.790(0.761~0.858)。结论:pSS-CNS临床表现多样,中枢神经系统的表现可以是部分患者首次出现的症状,也可以是唯一的临床症状,本研究中以NMOSD最为常见。IgG、IgM、CH50、PLT是pSS-CNS的独立危险因素,其中,PLT越高,IgG、IgM、CH50越低,发生中枢神经病变可能性越大。Objective:To explore the clinical manifestations and risk factors of primary Sjogren's syndrome associated central nervous system(pSS-CNS).Methods:A total of 291 patients with primary Sjogren's syndrome(pSS)in Nanfang Hospital of Southern Medical University from January 2015 to December 2020 were selected and divided into the pSS-CNS group and pSS-non-CNS group.The general conditions,laboratory data were collected to analyze the clinical characteristics between the two groups.Then multivariate Logistic regression analysis was performed on the risk factors of pSS-CNS,and ROC curve was drawn to evaluate the predictive value of each risk factor.Results:(1)pSS-CNS patients were mainly neuromyelitis optic spectrum disorders(NMOSD,15 cases,33.3%),the other 30 cases included leukoaraiosis,stroke,epilepsy,dementia and other central lesions.(2)pSS-CNS group had a higher European League Against Rheumatism Sjogren's Syndrome Disease Activity Index(ESSDAI)than p SSn CNS group[(11.14±2.97)vs(5.39±2.06),P<0.01].(3)The independent risk factors for p SSCNS were Ig G(OR:0.890;95%CI:0.826~0.959;P=0.002),Ig M(OR:0.367;95%CI:0.182~0.739;P=0.005),CH50(OR:0.935;95%CI:0.901~0.970;P<0.01),PLT(OR:1.005;95%CI:1.001~1.009;P=0.010),the following curves of the four area:0.890(0.826~0.959),0.367(0.182~0.739),0.935(0.901~0.970),1.005(1.001~1.009),and the area under the curve of the combined application of the four was 0.790(0.761~0.858).Conclusions:The clinical manifestations of pSS-CNS are varied.Some patients may present the symptoms of central nervous system as their first or only clinical symptom.In our study,NMOSD was the most common one.Ig G,Ig M,CH50 and PLT are independent risk factors for pSS-CNS,among which,the higher the PLT,the lower the Ig G,Ig M and CH50,and the higher the possibility of central neuropathy.

关 键 词：原发性干燥综合征 中枢神经系统损害 视神经脊髓炎谱系 危险因素分析 

分 类 号：R593.2[医药卫生—内科学] R741[医药卫生—临床医学]