初发神经精神狼疮患者神经精神损害危险因素分析

Risk factors for neuropsychiatric damages in the first-onset patients with neuropsychiatric systemic lupus erythematosus

目的探讨神经精神狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)患者出现神经精神损害的危险因素。方法参照系统性狼疮国际临床合作组与美国风湿病学会(SLICC/ACR)脏器损伤评价标准中的神经精神损伤评估对162例初次发病的NPSLE患者出院时的神经精神损伤情况(NPDI)进行评估,并以此分为神经精神损伤组(NPDI≥1)和无神经精神损伤组(NPDI=0)进行单因素分析,再将有意义的变量做多因素回归分析。结果单因素分析显示神经精神损伤患者狼疮疾病活动度(SLE disease activity index,SLEDAI)指数、急性意识障碍、认知障碍、癫痫、头痛、血小板数、C3、C4与无神经精神损伤患者比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示SLEDAI指数、急性意识障碍与神经精神损伤呈正相关(P<0.05);头痛与神经精神损伤呈明显的负相关(P<0.05)。结论 NPSLE患者疾病活动指数SLEDAI、急性意识障碍、头痛是患者神经精神损伤的重要影响因素,在临床上应该引起高度的关注。

Objective To investigate the risk factors for neuropsychiatric damages in the first-onset patients with neuropsychi-attic systemic lupus erythematosus. Methods Clinical data of 162 first-onset patient were retrospectively analyzed. The neuropsychiat-tic damages（NPDI） in the discharged patients were estimated according to the evaluation standards of organ injuries set up by SLICC. The patients were divided into neuropsychiatrie damage group（ NPDI ≥ 1 ）and non-neuropsychiattie damage group（ NPDI = 0）. Related factors were analyzed by using single factor analysis, and then multivariate regression analysis of variables if variables were meaningful. Results Single factor analysis showed that SLEDAI scores, acute disorders of consciousness, cognitive impairment, epilepsy, headache, platelet reduction, complement 3 and complement 4 were relative to neuropsychiatrie damages. Logiestic muti-faetor regression analysis revealed that SLEDAI scores （OR = 1.18 ）and acute disorders of consciousness （OR = 4. 442）were dangerous factors for acute disor-ders of consciousness （P 〈 0. 05）, and headache（ OR = 0. 338）was a protective factor（P 〈 0. 05 ）. Conclusion SLEDAI scores, a-cute disorders of consciousness, headache are relative to neuropsvchiatric damages. We should Day more attention to these.