儿童狼疮性肾炎合并神经精神狼疮的临床特征和危险因素  

Analysis of clinical characteristics and risk factors of lupus nephritis combined with neuropsychiatric systemic lupus erythematosus in children

作　　者：韩铠阳 冯铜铜 包瑛[2] Han Kaiyang;Feng Tongtong;Bao Ying(Graduate Studies Office,Xi'an Medical University,Xi'an 710021,China;Department of Nephrology,Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]西安医学院研究生工作处,陕西西安710021 [2]西安市儿童医院肾脏内科,陕西西安710003

出　　处：《临床荟萃》2024年第9期812-815,共4页Clinical Focus

摘　　要：目的探究狼疮性肾炎(lupus nephritis,LN)合并神经精神狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)患儿的临床特征,并分析LN患儿合并NPSLE的危险因素。方法纳入2017年5月至2024年1月在西安市儿童医院肾脏内科就诊的LN患儿119例,根据是否合并NPSLE分为NPSLE组(n=26)和非NPSLE组(n=93)。比较两组临床资料差异,分析LN患儿合并NPSLE的临床特征和危险因素。结果①本研究中,LN患儿合并NPSLE的发病率为21.8%,男女比例为1∶5.5,平均年龄为10岁6月;最常见的神经系统受累表现为精神异常,一般表现为盘形红斑,影像学表现为头颅MRI异常。②两组抗核抗体阳性、抗ds-DNA抗体阳性、抗SM抗体阳性、三系减少、仅贫血、血沉高(>15 mm/h)、低蛋白血症、Coombs试验阳性、血尿、大量蛋白尿指标等差异均有统计学意义(P<0.05)。③二元logistic回归分析显示,血尿、大量蛋白尿、抗SM抗体阳性是LN患儿合并NPSLE的独立危险因素。结论LN合并NPSLE的影响因素较多,其中血尿、大量蛋白尿、抗SM抗体阳性的LN患儿易并发神经精神改变。Objective To explore the clinical characteristics of children with lupus nephritis(LN)complicated with neuropsychiatric systemic lupus erythematosus(NPSLE),and to analyze the risk factors of LN complicated with NPSLE.Methods A total of 119 children with LN who were admitted to the Department of Nephrology,Xi'an Children's Hospital from May 2017 to January 2024 were enrolled.They were divided into NPSLE group(n=26)and non-NPSLE group(n=93)according to the presence or absence of NPSLE.Clinical data were compared between the two groups,and the clinical characteristics and risk factors of LN children with NPSLE were analyzed.Results The incidence of NPSLE in children with LN was 21.8%,with male-to-female ratio of 1∶5.5,and an average age of 10 years and 6 months.The most common neurological manifestations were psychiatric abnormalities,erythema discoideum in general,and abnormalities of cranial MRI on imaging.There were significant differences in antinuclear antibody positivity,anti-ds-DNA antibody positivity,anti-Smith(anti-SM)antibody positivity,reduction of white blood cells,red blood cells and platelets,performance of only anemia,high erythrocyte sedimentation rate(>15 mm/h),hypoproteinemia,positive Coombs test,hematuria and massive proteinuria between the two groups(P<0.05).Binary logistic regression analysis showed that hematuria,massive proteinuria and positive anti-SM antibody were independent risk factors for NPSLE in children with LN.Conclusion A variety of factors can influence whether LN is comorbid with NPSLE,with children with LN who have haematuria,large amounts of proteinuria,and positive anti-SM antibodies being prone to comorbid neuropsychiatric changes.

关 键 词：狼疮肾炎 狼疮血管炎 中枢神经系统 临床特征 危险因素 

分 类 号：R593.242[医药卫生—内科学] R512.39[医药卫生—临床医学]