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

doi:10.3969/j.issn.1004-583X.2024.09.008

摘要/Abstract

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。

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

Abstract:

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.

Key words: lupus nephritis, lupus vasculitis, central nervous system, clinical characteristic, risk factors

中图分类号:

韩铠阳, 冯铜铜, 包瑛. 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[J]. 临床荟萃, 2024, 39(9): 812-815.

Han Kaiyang, Feng Tongtong, Bao Ying. Analysis of clinical characteristics and risk factors of lupus nephritis combined with neuropsychiatric systemic lupus erythematosus in children[J]. Clinical Focus, 2024, 39(9): 812-815.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.09.008

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I9/812

图/表 3

表1 NPSLE组神经系统受累表现

Tab.1 Manifestations of neurological involvement in NPSLE group

神经系统表现	例数	发生率(%)
头痛	10	38.5
精神异常	16	61.5
急性意识错乱	4	15.4
无菌性脑膜炎	7	26.9
癫痫发作障碍	8	30.8
脱髓鞘综合征	9	34.6

表2 两组实验室资料比较[例(%)]

Tab.2 Laboratory data between the two groups

组别	例数		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
NPSLE组	26		23(100.0)		19(100.0)		11(78.6)		5(19.2)		4(15.4)		13(56.5)		7(29.2)
非NPSLE组	93		57(75.0)		56(70.0)		33(40.7)		4(4.8)		54(63.5)		71(86.6)		47(58.8)
χ²值			8.560		11.230		10.190		0.224		-0.408		-0.311		-0.249
P值			0.036		0.024		0.037		0.019		<0.001		0.001		0.011
组别		Coombs 试验阳性		血尿		大量蛋白尿		仅白细胞减少		仅红细胞减少		仅血小板减少		低补体 C3血症
NPSLE组		12(80.0)		10(38.5)		6(25.0)		14(53.8)		13(50.0)		4(15.4)		10(38.5)
非NPSLE组		35(49.3)		52(63.4)		52(68.4)		36(42.4)		38(44.7)		15(17.6)		21(26.3)
χ²值		0.214		-0.254		-0.376		0.098		0.015		-0.025		-0.01
P值		0.048		0.009		<0.001		0.307		0.877		0.791		0.919

表3 LN患儿合并NPSLE影响因素的二元logistic回归分析

Tab.3 Binary logistic regression analysis of influencing factors for LN children with NPSLE

因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	下限	上限
三系减少	-1.561	0.714	4.775	0.029	0.210	0.052	0.851
仅贫血	-2.260	0.588	14.749	<0.001	0.104	0.033	0.331
高血沉	-1.602	0.531	9.108	0.003	0.201	0.071	0.570
低蛋白血症	-1.241	0.503	6.080	0.014	0.289	0.108	0.775
血尿	1.243	0.490	6.438	0.011	3.467	1.327	9.057
大量蛋白尿	1.872	0.532	12.375	<0.001	6.500	2.291	18.443
抗核抗体阳性	1.078	1.357	0.631	0.427	2.939	0.206	41.990
抗ds-DNA抗体阳性	0.642	0.456	1.980	0.159	1.900	0.777	4.643
抗SM抗体阳性	1.305	0.442	8.697	0.003	3.686	1.549	8.773
Coombs试验阳性	0.858	0.909	0.892	0.345	2.359	0.397	14.001

表3 LN患儿合并NPSLE影响因素的二元logistic回归分析

Tab.3 Binary logistic regression analysis of influencing factors for LN children with NPSLE

因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	P值	$O R$ 值	下限	上限
三系减少	-1.561	0.714	4.775	0.029	0.210	0.052	0.851
仅贫血	-2.260	0.588	14.749	<0.001	0.104	0.033	0.331
高血沉	-1.602	0.531	9.108	0.003	0.201	0.071	0.570
低蛋白血症	-1.241	0.503	6.080	0.014	0.289	0.108	0.775
血尿	1.243	0.490	6.438	0.011	3.467	1.327	9.057
大量蛋白尿	1.872	0.532	12.375	<0.001	6.500	2.291	18.443
抗核抗体阳性	1.078	1.357	0.631	0.427	2.939	0.206	41.990
抗ds-DNA抗体阳性	0.642	0.456	1.980	0.159	1.900	0.777	4.643
抗SM抗体阳性	1.305	0.442	8.697	0.003	3.686	1.549	8.773
Coombs试验阳性	0.858	0.909	0.892	0.345	2.359	0.397	14.001

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