摘要
目的总结儿童神经精神性狼疮(NPSLE)的临床特征及危险因素。方法回顾分析2013年1月至2018年12月住院治疗的SLE患儿的临床资料。结果纳入315例SLE患儿中,58例确诊NPSLE,男11例、女47例,平均年龄(10.45±2.63)岁;共出现14种神经精神症状,依次为头痛21例、癫痫发作19例、脑血管意外15例、脱髓鞘综合征13例、情绪失调10例。58例NPSLE患儿均行头颅影像学检查,异常53例(91.4%);44例行脑电图检查,异常38例(86.4%);39例行脑脊液检查,异常34例(87.2%)。首次发病发生NPSLE较未发生NPSLE的患儿,血小板计数<100×10^(9)/L的发生率高,差异有统计学意义(P<0.05)。2013年1月至2015年12月发病的23例患儿病死率为21.7%,高于2016年1月至2018年12月发病的35例患儿(病死率2.9%),差异有统计学意义(P<0.05)。多元logistic回归分析表明,血小板计数降低、抗心磷脂抗体阳性、激素治疗不规范是发生NPSLE的独立危险因素(P<0.05)。结论NPSLE以头痛、癫痫发作最多见,血小板计数降低的NPSLE患儿更早出现神经精神症状。近年NPSLE患儿病死率较前有所降低。血小板计数降低、抗心磷脂抗体阳性、激素治疗不规范是SLE患儿发生NPSLE的危险因素。
Objective To explore the clinical features and risk factors of neuropsychiatric systemic lupus erythematosus(NPSLE)in children.Methods The clinical data of SLE in children hospitalized from January 2013 to December 2018 were retrospectively analyzed.Results A total of 315 children with SLE were included.58(11 boys and 47 girls)were diagnosed with NPSLE and an average age was 10.45±2.63 years.There were 14 kinds of neuropsychiatric symptoms,including headache(21 cases),epileptic seizure(19 cases),cerebrovascular accident(15 cases),demyelinating syndrome(13 cases)and emotional disorder(10 cases).Fifty-eight children with NPSLE underwent cranial imaging examination,and 53 cases(91.4%)were abnormal;44 cases underwent EEG examination,and 38 cases(86.4%)were abnormal;39 cases underwent cerebrospinal fluid examination,and 34 cases(87.2%)were abnormal.The incidence of platelet count <100×10^(9)/L was higher in children at first-onset of NPSLE than that in children without NPSLE,and the difference was statistically significant(P<0.05).The case fatality rate of the 23 children(21.7%)who developed disease from January 2013 to December 2015 was higher than that of the 35 children(case fatality rate of 2.9%)who developed disease from January 2016 to December 2018,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that decreased platelet count,positive anticardiolipin antibodies,and irregular hormone therapy were independent risk factors for NPSLE(P<0.05).Conclusions The most common symptoms of NPSLE are headache and seizures,and children with decreased platelet count have earlier neuropsychiatric symptoms.The mortality rate of children with NPSLE has decreased in recent years.Low platelet count,positive anticardiolipin antibody,and nonstandard hormone therapy are the risk factors for NPSLE in children with SLE.
作者
石丹英
李杏
韩蕴丽
周春
SHI Danying;LI Xing;HAN Yunli;ZHOU Chun(Department of Pediatrics,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,Guangxi,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2021年第6期437-441,共5页
Journal of Clinical Pediatrics
关键词
神经精神性狼疮
危险因素
儿童
neuropsychiatric systemic lupus
risk factor
child
