系统性红斑狼疮合并视网膜微血管阻塞的临床观察

Clinical observation of systemic lupus erythematosus complicated with retinal microvascular obstruction

目的观察合并视网膜微血管阻塞的系统性红斑狼疮（SLE）患者的临床特点及视网膜微血管阻塞的临床转归情况。方法选取2011年1月～2014年6月荆州市中心医院合并视网膜微血管阻塞（棉绒斑）的SLE患者32例55眼为实验组，另选取同期不合并视网膜病变的SLE患者30例60眼为对照组。记录两组患者临床症状和体征，完善相关实验室检查（血尿常规、肾功能、血沉、自身抗体及胸片、心脏彩超）。眼科随访12个月，记录随访开始及结束时最佳矫正视力（BCVA）、眼压（IOe）、SLE疾病活动指数（SLEDAI）评分、棉绒斑变化及治疗情况。结果实验组皮肤红斑、中枢神经系统症状发生率显著高于对照组，差异均有统计学意义（P〈0．05或P〈0．01）；抗ds—DNA抗体阳性率、补体C3降低和血沉升高发生率显著高于对照组，差异均有统计学意义（P〈0．05）。随访开始时实验组SLEDAI评分[（14．24±4．27）分]显著高于对照组[（9．03±3．16）分]（P〈0．01），随访结束时评分为（9．38±2．81）分，较开始时显著降低（P〈0．01），且与对照组[（8．75±2．64）分]比较差异无统计学意义（P〉0．05）。棉绒斑显著减少（46眼缓解），其中6眼行局部视网膜光凝治疗。两组患者随访开始及随访结束时BCVA和IOP比较，差异均无统计学意义（P〉0．05）。结论合并视网膜微血管阻塞的SLE患者多处于疾病的中度活动期，与全身多系统受累表现一致。棉绒斑可提示疾病的进展及控制情况，应定期行眼底检查，同时进行积极眼部治疗可防止视功能受损。

Objective To observe the clinical characteristics of SLE patients complicated with retinal microvascular obstruction, and the clinical outcome of retinal microvascular obstruction. Methods 32 SLE patients （55 eyes） with retinal microvascular obstruction （cotton-wool spot） were selected as the experimental group in Jingzhou Central Hospital from January 2011 to June 2014, and 30 SLE patients （60 eyes） without retinopathy as the control group. The clinical symp- toms and signs of the two groups were recorded; the related laboratory tests （routine blood and urine tests, renal function, erythrocyte sedimentation rate, autoantibody and chest X-ray, echoeardiography） were carried out. In 12 months ophthalmic follow-up, the best corrected visual acuity （BCVA）, intraocular pressure （IOP）, SLEDAI score, the changes of cotton-wool spots and treatment condition were recorded. Results Incidence rate of skin erythema and central nervous system symptoms in the experimental group was significantly higher than the control group, the differences were statistically signifieant（P 〈 0.05 or P 〈 0.01）. The positive rate of anti ds-DNA antibody, the incidence rate of complement C3 decreased and erythrocyte sedimentation rate increased were significantly higher than the control group, the differences were statistically significant （P 〈 0.05）. At the beginning of the follow-up, the SLEDAI score of the experimental group [（14.24±4.27） scores] was significantly higher than the control group [（9.03±3.16） scores] （P 〈 0.01）, and at the end of follow-up, the score [（9.38±2.81） scores] was significantly lower than the beginning of follow-up （P 〈 0.01）, and there was no significant difference between two groups （P 〉 0.05）. Cotton-wool spots decreased significantly （46 eyes relief）; 6 eyes received local photocoagulation treatment. There was no significant difference in visual acuity and intraocular pressure between the two groups at the beginning and end of the follow-up （P 〉 0.05）. Conclusion SLE patients complicated with retinal microvascular obstruction are in the moderate active stage with multiple system involvement. Cotton-wool spots can prompt the progress and control of the disease, fundus examination should be performed regularly, while actively ophthalmologic treatment can prevent visual impairment.