原发性干燥综合征所致精神障碍临床特征的回顾性分析

Retrospective analysis of the clinical features of patients with mental disorder caused by sjogrensyndrome

目的探讨原发性干燥综合征（pSS）所致精神障碍的临床特征。方法对31例由风湿免疫科和精神科联合会诊确诊为pSS所致精神障碍住院患者的临床资料，从临床表现、辅助检查、治疗措施及疗效等方面进行回顾性分析。结果31例患者中男7例，女24例；确诊前有23例在精神科首次就诊住院，5例在精神科多次就诊住院，3例在风湿免疫科就诊住院。物理检查结果均无特异性。31例患者的红细胞沉降率、C反应蛋白和免疫球蛋白G均升高；唇腺组织学检查均显示，腺上皮萎缩，灶性淋巴细胞浸润；24例抗核抗体阳性，25例抗干燥综合征抗原A抗体阳性。确诊pSS前主要精神症状以焦虑和抑郁为主要表现。21例患者的汉密尔顿焦虑量表（HAMA）评分为8-25（15．84±5．76）分，其中6例患者汉密尔顿抑郁量表（17项）评分为14-23（19．50±4．23）分，伴随症状体征出现较早，自觉疲乏21例，口干18例，皮肤干燥17例，睡眠障碍（入睡困难或早醒）16例，眼干涩14例，猖獗龋齿12例。通过系统治疗，31例患者中28例精神症状明显好转，2例继续精神科治疗，1例因脑炎死亡。结论pSS所致精神障碍临床表现复杂多样，缺乏特异性；精神障碍多为焦虑和抑郁等；很多躯体症状易与焦虑或抑郁混淆。

Objective To investigate the clinical features of patients with mental disorder caused by primary sjogren syndrome （ pSS ） . Methods The retrospective analysis was made on the perspectives of clinical manifestation, accessory examinations, therapeutic measure and treatment effect, etc. , on 31 inpatients who were diagnosed of mental disorder caused by pSS through the collaborative diagnosis with the doctors from departments of rheumatism immunity and psychosis. Results Twenty-four patients were female. Before the correct diagnoses being made, 23 patients were hospitalized to the psychosis department in the first diagnosis, 5 were diagnosed as mental disorders and shifted into the hospital in the psychosis department, and 3 were diagnosed in the rheumatism immunity department. The physical examination was nonspecific. The erythrocyte sedimentation rate（ESR） , C-reactive protein（CRP） and immunoglobulin in the 31 patients were all increased, while gland epithelial atrophy was examined by the labial gland histology examination, loci lymphocyte infiltrates were also found. The antinuclear antibodies （ANA） was positive in 24 patients, the anti-sjogren syndrome antigen A （ anti-SSA ） was positive in 25 patients. Anxiety and depression were regarded as the primary mental symptom before the diagnosis of pSS. The score of Hamilton Anxiety Scale （HAMA） of 21 patients was 8 - 25 （ 15.84 ± 5.76）, while the score of Hamilton Depression Scale （ 17 items, HAMD17 ） of 6 patients was 14 - 23 （ 19.50± 4. 23 ） , and accompanying physical symptoms as weary（21 patients）, thirsty（ 18 patients）, dry skin（ 17 patients）, sleep disturbances （sleep continuity disturbance and early awake）（ 16 patients）, dry eye （14 patients） and various dental caries（ 12 patients） occurred early. With the systematic treatment, 28 patients had the marked improvement, 2 had continuous psychosis treatment, and 1 died because of encephalitis. Conclusion The clinical manifestationsof mental disorder caused by pSS are various and have comparatively difference without specificity. Most of the mental disorders are manifested as depression and anxiety, while lots of physical symptoms are confused with anxiety and depression.