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

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

Abstract

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

CLC Number:

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.09.008

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

Figures/Tables 3

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

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

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

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

References 20

[1]	刘平丹. 血浆细胞外囊泡、Serpinc1在系统性红斑狼疮中的表达及其作用[D]. 南充: 川北医学院, 2023.
[2]	Hou Y, Wang L, Luo C, et al. Clinical characteristics of early-onset paediatric systemic lupus erythematosus in a single centrein China[J]. Rheumatology(Oxford), 2023, 62(10):3373-3381.
[3]	端爱萍, 高少辉, 鲍浩. 溶酶体在肾小球疾病中的研究进展[J]. 肾脏病与透析肾移植杂志, 2024, 33(1):54-58.
[4]	罗玉立, 杨一帆, 罗家昂, 等. 神经精神狼疮血脑屏障损伤机制的研究进展[J]. 医学综述, 2020, 26(19):3758-3762+3768.
[5]	程程, 文思佳, 林知朗, 等. 儿童狼疮性肾炎的疗效及预后分析[J]. 中华儿科杂志, 2021, 59(9):730-736.
[6]	Nie S, He W, Huang T, et al. The spectrum ofbiopsy-proven glomerular diseases among children in china: A national, cross-sectional survey[J]. Clin J Am Soc Nephrol, 2018, 13(7): 1047-1054.
[7]	赵娟, 屈嘉豪, 刘力源, 等. 神经精神狼疮109例临床特点及生存分析[J]. 中华风湿病学杂志, 2021, 25(11):733-738.
[8]	Aringer M. EULAR/ACR classification criteria for SLE[J]. Semin Arthritis Rheum, 2019, 49(3S):S14-S17.
[9]	Amorim JC, Frittoli RB, Pereira D, et al. Epidemiology, characterization, and diagnosis of neuropsychiatric events in systemic lupus erythematosus[J]. Expert Rev Clin Immunol, 2019, 15(4):407-416.
[10]	Waldman M, Madaio MP. Pathigenic autoatibodies in lupus nephritis[J]. Lups, 2005, 14(1):19-24.
[11]	石丹英, 儿童神经精神狼疮临床特征及危险因素分析[D]. 南宁: 广西医科大学, 2020.
[12]	Ahn GY, Kim D, Won S, et al. Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: A prospective, single-center study[J]. Lupus, 2018, 27(8) :1338-1347. doi: 10.1177/0961203318772021 pmid: 29688144
[13]	郭旭娟, 刘秀梅. 系统性红斑狼疮脑病危险因素的meta分析[J]. 中国免疫学杂志, 2020, 36(4):484-490.
[14]	孟庆防. 系统性红斑狼疮并狼疮脑病临床特点分析[J]. 中国实用神经疾病杂志, 2017, 20(6):86-88.
[15]	Brandusa F, Ellie A, Jiandong S, et al. Peripheral neu-ropathy in patients with systemic lupus erythematosus[J]. Semin Arthritis Rheum, 2012, 41(2):203-211.
[16]	Luyendijk J, Steens SC, Ouwendijk WJ, et al. Neuropsychiatric systemic lupus erythematosus:Lessons learned from magnetic resonance imaging[J]. Arthritis Rheum, 2014, 63(3):722-732.
[17]	Dale RC, Fabienne B, Duffy LV, et al. Utility andsafety of rituximab in pediatric autoimmune and inflammatory CNS disease[J]. Neurology, 2014, 83(2):142-150.
[18]	凌磊, 皮肖冰, 余旸弢, 等. 系统性红斑狼疮患者血清干扰素-α的水平变化及其临床意义[J]. 实用医学杂志, 2016, 32(1):106-108.
[19]	Furie R, Merrill JT, Werth VP, et al. Anifrolumab,an antiinterferon-α receptor monoclonal antibody,in moderate-to-severe systemic lupus erythematosus[J]. Arthritis Rheumatol, 2017, 69(2):376-386.
[20]	Huang MW, Stock AD, Mike EV, et al. Anti-IFNAR treatment does not reverse neuropsychiatric disease in MRL//lpr lupus mice[J]. Lupus, 2019, 28(13):1510-1523. doi: 10.1177/0961203319872265 pmid: 31474191