儿童系统性红斑狼疮95例临床分析

Clinical characteristics of 95 children with systemic lupus erythematosus

目的探讨儿童系统性红斑狼疮（SLE）的临床特点。方法对2003年1月至2013年12月在无锡市儿童医院住院的首次确诊为SLE的95例患儿资料进行回顾性分析，比较男性SLE患儿与女性SLE患儿临床特点，采用∥检验进行统计学分析。结果95例SLE患儿中男12例，女83例。临床表现：面部皮疹69例（72．6％）、发热43例（45．3％）、关节炎31例（32．6％）、浆膜炎24例（25．3％）、口腔溃疡23例（24．2％）、目光过敏13例（13．7％）、神经系统损害11例（11．6％）。实验室检查：抗核抗体阳性94例（98．9％）、C3下降91例（95．6％）、抗双链DNA（dsDNA）抗体阳性71例（74．7％）、C4下降71例（74．7％）、抗SSA抗体阳性69例（72．6％）、抗Sm抗体阳性62例（65．3％）、蛋白尿52例（54．7％）、抗SSB抗体阳性49例（51．6％）、白细胞减少46例（48．4％）、抗核小体抗体阳性38例（40．0％）、贫血38例（40．0％）、血尿26例（27．4％）、血小板减少14例（14．7％）、。肾功能损害6例（6．3％）。男性SLE患儿肾脏损伤、抗Sm抗体和抗核小体抗体阳性率均显著高于女性患儿（X^2=9．989、4．224、4．070，P均〈0．05）；女性SLE患儿抗SSB抗体阳性率显著高于男性患儿（X2=3．885，P〈0．05）。结论男性SLE患儿易出现肾脏损伤，以蛋白尿最常见。抗Sm抗体是男性SLE患儿肾损伤高发的危险因素。抗核小体抗体是男性SLE患儿疾病活动度高于女性患儿的危险因素。女性SLE患儿今后发生干燥综合征的风险高于男性患儿。

Objective To investigate the clinical features of children with systemic lupus erythematosus （SLE）. Methods Ninety-five patients hospitalized in Wuxi Children＇s Hospital from Jan. 2003 to Dec. 2013 were analyzed retrospectively. They were diagnosed as SLE for the first time. The clinical features of SLE between boys and girls were compared. Chi-square test was used for statistical analysis. Results Of the 95 cases with SLE, 12 were boys and 83 were girls. Clinical manifestations showed 69 cases with facial rash （72.6%） ,43 cases with fever （45.3%） ,31 cases with arthritis （32.6%） ,24 cases with serositis （25.3%） ,23 cases with oralulcer （24.2%）, 13 cases with allergy to sunlight （ 13.7% ）, 11 cases with nervous system damage （ 11.6% ）. Laboratory examination ： 94 cases （98.9%） with anti-nuclear antibody positive,91 cases （95.6%） with decreased C3 complement,71 cases （74.7%） with anti-ds- DNA antibody positive,71 cases（74.7% ） with decreased C4 complement,69 cases （72.6%） with anti-SSA antibody positive,62 cases （65.3%） with anti-Sin antibody positive,52 cases （54.7%） wiht proteinuria,anti-SSB antibody positive 49 cases（51.6% ） ,46 cases （48.4%） with decreased leukocyte,38 cases（40.0% ） with anti-nucleosome anti- body,38 cases （40.0%） with anemia,26 cases（27.4% ） with hematuresis, 14 cases（ 14.7% ） with decreased platelet,6 cases （6.3%） with injury of renal function. Renal injury, anti-Sin antibody and anti-nucleosome antibody of male children with SLE were significantly higher than those of female children（x＂ =9. 989,4. 224,4. 070,all P 〈0.05 ）. The positive rate of anti-SSB antibody in female children with SLE was significantly higher than that of male children（X^2 = 3. 885 ,P 〈 0.05）. Conclusions Male childre with SLE are easy to appear the renal injury, proteinuria is the most common. Anti-Sin antibody is a risk factor for the high incidence of renal injruy in male children with SLE. Anti-nueleo- some antibody is a risk factor for the high incidence of SLE disease activity in male children than that of female children. The risk of future Sjogren＇s syndrome in female children with SLE is higher than that of male children.