儿童系统性红斑狼疮伴肺胸膜病变的临床特征分析

Clinical features of systemic lupus erythematosus with pulmonary pleural lesion in children

目的:了解儿童系统性红斑狼疮(SLE)肺胸膜病变受累的临床特征并分析其相关因素。方法:收集2001年1月至2010年12月共10年,收住在浙江大学医学院附属儿童医院初诊的非感染性SLE患儿133例的临床资料,回顾分析其肺胸膜病变的临床特征、影像学表现及相关实验室指标。结果:133例SLE患儿中并发肺胸膜病变者45例(33.83%),其中有呼吸系统表现者30例(66.67%),无呼吸系统表现者15例(33.33%);呼吸系统最常见临床症状为咳嗽咳痰(55.56%),其次为呼吸困难和胸痛(15.56%和11.11%);只有28.89%患儿肺部可闻及干和/或湿性罗音。肺胸膜病变类型以胸腔积液/胸膜炎最多(32例,71.11%),其次为支气管肺炎样改变(21例,46.67%)和肺间质病变(13例,28.89%)。与无肺胸膜病变组比较,肺胸膜病变组患儿白细胞减少、补体C3减低、抗dsDNA抗体(+)发生率更高,差异均有统计学意义(P<0.05);两组间血沉、C反应蛋白及血小板异常,免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)异常,以及抗核抗体(+)、抗SSA抗体(+)、抗SSB抗体(+)、抗Sm抗体(+)发生率的差异无统计学意义(P>0.05)。结论:儿童SLE累及肺胸膜病变发生率高,临床表现缺乏特异性,部分病例可无呼吸系统症状或体征,但白细胞减少、补体C3减低、抗dsDNA抗体(+)的SLE患儿肺胸膜病变发生率较高。建议SLE患儿常规行胸片或HRCT检查。

Objective： To investigate the clinical features of systemic lupus erythematosus （SLE） with pulmonary pleural lesion in children. Methods： One hundred and thirty three child patients with SLE admitted from 2001 to 2010 were enrolled in the study. The clinical data, chest X-ray findings and laboratory examination were retrospectively reviewed. Cases with infectious pulmonary pleural lesion were excluded. Results： According to chest X-ray findings pleural pulmonary lesions were involved in 45 out of 133 cases with SLE （33. 83% ）; however, only 30 cases （66. 67% ） had positive respiratory manifestations. Respiratory features included cough and/or sputum （55.56%）, dyspnea and chest pain （15.56% and 11.11% ）, and only 28.89% case with pleural pulmonary lesions had rales. Chest X-ray findings included pleural effusion / pleurisy （32 cases, 71.11% ） , bronchial pneumonia （21 cases, 46.67% ） or interstitial pulmonary disease（ 13 cases,28.89% ）. Compared to children without pulmonary pleural lesion, children with pulmonary pleura1 lesion had higher incidence of leukopenia, lower C3 or antibody dsDNA （ ＋ ） （all P 〈 0. 05 ）. There was no difference in abnormality of erythrocyte sedimentation rate （ ESR）, CRP, IgG, IgA, IgM, thrombocytopenia, antibody ANA （ ＋ ）, anti-SSA （ ＋ ）, anti-SSB（ ＋ ） or anti-Sm（ ＋ ） between children with or without pulmonary pleural lesion （P 〉 0.05 ）. Conclusions： High incidence of pulmonary pleura lesions are present in children with SLE, however, clinical manifestations are lack of specificity or even no respiratory manifestation. Chest X-ray or HRCT scan are necessary in all cases with SLE. Children with leukopenia,lower C3 or antibody dsDNA （ ＋ ） are more likely to have pulmonary pleural lesion.