系统性红斑狼疮外周神经病的临床分析

Clinical analysis of peripheral neuropathy in patients with systemic lupus erythematosus

目的 探讨系统性红斑狼疮（SLE）外周神经病（PN）的发病率及其临床特点,以便早期发现及治疗,提高患者生活质量.方法 北京协和医院1995年1月至2011年8月间住院的SLE相关PN（SLE-PN）患者共67例,对其临床特点及预后进行回顾性分析,并与应用等距抽样法抽取的201例同时期无SLE相关PN患者进行对比分析.统计学处理采用x2检验、t检验和Mann-Whitney检验.结果 SLE患者PN的患病率是1.5％（67/4514）.共发生72例次PN,5例次（7.5％）患者同时存在2种类型的PN.7种类型PN中,以多神经病最为常见（45例次,62.5％）,其次是单神经病（9例次,12.5％）、重症肌无力（8例次,11.1％）、颅神经病（7例次,9.7％）、自主神经病（2例次,2.8％）及吉兰巴雷综合征（1例次,1.4％）,未见神经丛病.PN的临床表现以相应部位的肌无力及麻木（37例次,51.4％）最为常见,而6.9％（5例次）PN并无PN的相应临床表现,为神经电生理检查发现.随诊0.3～124个月,平均（6±17）个月,大多数PN（51例次,70.8％）经过治疗症状能够减轻.SLE-PN的患者与无SLE相关PN的患者在年龄[（37±14）岁与（32±14）岁,P＜0.05],发热[44例（65.7％）与96例（47.8％）,P＜0.05],肌炎[12例（17.9％）与10例（5.0％）,P＜0.01],皮肤黏膜[54例（80.6％）与120例（59.7％）,P＜0.01],中枢神经系统受累[26例（38.8％）与40例（19.9％）,P＜0.01],消化系统受累[4例（6.0％）与37例（18.4％）,P＜0.05],抗Sm抗体阳性[34.4％（22/64）与18.6％（33/177）,P＜0.05],抗RNP抗体阳性[46.9％（30/64）与29.9％（53/177）,P＜0.05],IgG升高[52.4％（33/63）与30.1％（44/146）,P＜0.01],SLEDAI评分[12.0（9.0）与9.5（10.8）,P＜0.05]上差异有统计学意义.结论 SLE-PN并不罕见,病情相对较活跃,易出现发热、中枢神经系统、皮肤黏膜及肌炎表现.多科协作综合治疗,有助于改善症状、提高生活质量.

Objective To investigate the frequence and clinical characteristics of peripheral neuropathy （PN） of patients with systemic lupus erythematosus （SLE） in China.Methods The data of 67 consecutive PN related with SLE （SLE-PN） patients admitted to Peking Union Medical College Hospital （PUMCH） during January 1995 to August 2011 were retrospectively analyzed.At the same time,a total of 201 cases were randomly selected as controls from 4447 SLE patients without SLE-PN in PUMCH during the same period.Chi-square test,t test and Mann-Whitney test were used for statistical analysis.Results The prevalence of SLE-PN in SLE patients was 1.5％（67/4514）.Seventy-two cases of PN were discovered in 67 patients.Polyneuropathy was the most frequent presentation and was diagnosed in 45 cases（62.5％）,mononeuropathy in 9 cases （12.5％）,myasthenia gravis in 8 cases （11.1％）,cranial neuropathy in 7 cases （9.7％）,autonomic disorder in 2 cases （2.8％） and acute inflammatory demyelinating polyradiculoneuropathy in 1 case （1.4％）.No plexopathy was diagnosed.No symptoms were observed in 5 cases （6.9％） PN.There were differences between SLE patients with and without SLE-PN in age[（37±14） years vs （32±14） years,P＜0.05],fever（65.7％ vs 47.8％,P＜0.05）,myositis （17.9％ vs 5.0％,P＜0.01）,skin and mucous involvement of skin and mucous （80.6％ vs 59.7％,P＜0.01）,central nervous system involvement （38.8％ vs 19.9％,P＜0.01）,gastrointestinal involvement （6.0％ vs 18.4％,P＜0.05）,anti-Sm antibody positivity （34.4％ vs 18.6％,P＜0.05）,anti-RNP antibody positivity （46.9％ vs 29.9％,P＜0.05）,elevation of IgG （52.4％ vs 30.1％,P＜0.01）,and SLEDAI score [12.0（9.0） vs 9.5（10.8）,P＜0.05].Conclusion SLE-PN is not rare in patients with SLE.SLE patients with peripheral neuropathy tend to have more active disease.Multidisciplinary collaboration and comprehensive treatment can help to relieve pain and improve the quality of life.