摘要
目的探讨儿童初诊系统性红斑狼疮(SLE)合并头颅影像学异常的发生率及其临床特点。方法回顾性分析2012年1月至2019年5月西安交通大学附属儿童医院风湿免疫科收治的74例初诊SLE患儿临床资料,根据影像学情况分为头颅影像学异常组和头颅影像学无异常组,对2组SLE患儿初诊前病程、性别、皮疹、关节肿痛、脱发、肺间质病变、白细胞(WBC)、血红蛋白(Hb)、血小板(PLT)、红细胞沉降率(ESR)、血清铁蛋白(FER)、血清补体(C_(3)、C_(4))、抗心磷脂抗体(ACA)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、总胆固醇(TC)等指标进行描述并进行统计学分析。结果74例初诊SLE患儿均行头颅影像学检查,其中行头颅磁共振成像(MRI)52例、CT 22例,异常36例(48.6%),包括MRI 27例(51.9%)和CT 9例(40.9%)。36例头颅影像学异常SLE患儿中,MRI以脱髓鞘病变及脑沟增宽(脑萎缩)为主,CT以脑沟增宽(脑萎缩)为主;出现神经系统症状21例,包括头痛17例、头晕11例、抽搐3例、昏迷1例。2组SLE患儿比较,初诊前病程、性别、皮疹、关节肿痛、脱发差异均无统计学意义。36例头颅影像学异常的初诊SLE患儿合并肺间质病变20例,其中4例出现肺出血;38例头颅影像学无异常的初诊SLE患儿中合并肺间质病变8例,2组比较差异有统计学意义。2组实验室检查指标比较,PLT差异有统计学意义;WBC、Hb、ESR、FER、C_(3)、C_(4)、ACA、ALT、AST、TG、HDL、LDL、TC差异均无统计学意义。结论儿童SLE头颅影像学异常特别是MRI异常出现较早,可发生于神经系统临床症状之前,并与血液系统异常及肺部病变等重要脏器损害相关,早期发现有可能改善短期预后。
Objective To investigate the incidence and clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus(SLE)at the initial diagnosis.Methods The clinical data of 74 children with SLE admitted to the Department of Rheumatology in Children′s Hospital Affiliated to Xi′an Jiaotong University for the initial diagnosis from January 2012 to May 2019 were subject to retrospective analysis.They were divided into the cranial imaging abnormality group and the cranial imaging non-abnormality group according to the imaging.A description and statistical analysis were carried out for both groups with respect to the course before initial diagnosis,gender,rash,arthralgia,hair loss,pulmonary lesions,white blood cells(WBC),hemoglobin(Hb),platelets(PLT),erythrocyte sedimentation rate(ESR),serum ferritin(FER),serum complement values(C_(3) and C_(4)),anticardiolipin antibody(ACA),alanine aminotransferase(ALT),aspartate transaminase(AST),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),and total cholesterol(TC).Results Seventy-four children with SLE underwent a cranial imaging exa-mination at the initial diagnosis,including 52 cases for magnetic resonance imaging(MRI)and 22 cases for CT.There were 36 abnormal cases(48.6%),including 27 cases(51.9%)in MRI and 9 cases(40.9%)in CT.Among 36 cases of abnormal cranial imaging in children with SLE,MRI abnormalities were mainly demyelinating lesions and sulcus widening(brain atrophy),while CT abnormalities were mainly sulcus widening(brain atrophy).There were 21 cases presenting with neurological symptoms,including 17 cases of headache,11 cases of dizziness,3 cases of convulsions,and 1 case of coma.There were no significant differences between both groups in the course before initial diagnosis,gender,rash,arthralgia and hair loss.Among the 36 cases of SLE with cranial imaging abnormalities,20 cases presented with interstitial pulmonary lesions,of which 4 cases presented with pulmonary hemorrhage;Among 38 cases of SLE without cranial imaging abnormality,8 cases presented with interstitial pulmonary lesions,which indicated that there were statistical differences between both groups;within terms of the laboratory test items,there were significant differences in PLT between both groups,and there was no significant difference in WBC,Hb,ESR,FER,C_(3),C_(4),ACA,ALT,AST,TG,HDL,LDL and TC.Conclusions The cranial imaging abnormalities in children with SLE,especially the earlier occurrence in MRI,may occur before the manifestation of clinical symptoms of the nervous system.They were also associated with other important organ damages,such as abnormal blood system and lung lesions.Early detection may contribute to the short-term prognosis.
作者
耿玲玲
王利
李丹
冯媛
南楠
马凯
李小青
Geng Lingling;Wang Li;Li Dan;Feng Yuan;Nan Nan;Ma Kai;Li Xiaoqing(Department of Rheumatology,Children′s Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710003,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2021年第13期1015-1018,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
西安市科技计划项目(SF1509)。
关键词
系统性红斑狼疮
神经精神性狼疮
头颅影像学
肺间质病变
儿童
Systemic lupus erythematosus
Neuropsychiatric systemic lupus erythematosus
Cranial imaging
Pulmonary lesions
Child
