SLE伴视网膜病变的临床特征分析

Clinical analysis of SLE patients with retinopathy

目的:探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)伴视网膜病变的临床特征。方法:选取2015-02/2017-02在我院治疗的SLE患者121例,其中有视网膜病变30例(观察组),无视网膜病变91例(对照组),比较两组临床表现、实验室检查结果等。结果:观察组患者6例双眼视网膜病变,24例单眼视网膜病变;视网膜棉絮样渗出、视网膜血管阻塞和视网膜出血病变常见,分别占33%、25%和19%。观察组患者皮疹、皮肤血管炎和雷诺现象发生率分别为63%、47%和37%,均明显高于对照组(P<0.05);观察组和对照组患者黏膜溃疡、关节炎、神经精神症状和胸膜炎发生率比较,差异均无统计学意义(P>0.05)。观察组患者抗ds-DNA阳性率(63%)明显高于对照组(P<0.05);观察组和对照组患者蛋白尿≥3+、抗Sm抗体阳性、rRNP阳性和抗磷脂抗体阳性比例比较,差异均无统计学意义(P>0.05)。观察组患者SLEDAI评分为20.14(9,30)分,明显高于对照组(P<0.05)。观察组患者改良Ben Ezra评分为10.04±3.15分,与SLEDAI评分呈正相关(rs=0.706,P<0.05)。结论:SLE伴视网膜病变患者眼底主要表现为棉絮样斑、视网膜血管阻塞和视网膜出血;皮疹、皮肤血管炎、雷诺现象、抗ds-DNA抗体阳性在SLE伴视网膜病变患者中常见;改良Ben Ezra评分在评估SLE疾病活动及视网膜血管病变中有一定作用。

AIM:To investigate the clinical characteristics of patients with systemic lupus erythematosus(SLE)complicated with retinopathy.METHODS:Totally 121 cases of SLE patients treated in our hospital from February 2015 to February 2017 were selected,including 30 cases with retinopathy(observation group)and 91 cases without retinopathy(control group),the clinical manifestations and laboratory examination results of the two groups were compared.RESULTS:In the observation group,there were 6 patients with bilateral retinopathy and 24 patients with monocular retinopathy.Cotton retinal exudation,retinal vascular occlusion and retinal hemorrhage lesions were common,accounted for 33%,25%and 19%.The incidence of skin rash,skin vasculitis and Raynaud's phenomenon in the observation group were 63%,47%and 37%,respectively,which were significantly higher than those in the control group(P<0.05).There were no significant difference in the incidence of mucosal ulcer,arthritis,neuropsychiatric symptoms and pleurisy between the observation group and the control group(P>0.05).The positive rate of anti ds-DNA in the observation group was 63%,which was significantly higher than that in the control group(P<0.05).The observation group and the control group urine protein≥3+,anti Sm antibody positive and rRNP positive and antiphospholipid antibody percentage differences were not statistically significant(P>0.05).The SLEDAI score of the observation group was 20.14(9,30)points,which was significantly higher than that of the control group(P<0.05).The modified BenEzra score of the observation group was 10.04±3.15,and was positively correlated with the SLEDAI score(rs=0.706,P<0.05).CONCLUSION:SLE with fundus retinopathy patients mainly manifest as cotton wool spots,retinal vascular occlusion and retinal hemorrhage;rashes,vasculitis,Raynaud's phenomenon,and anti ds-DNA antibodies are common in SLE patients with retinopathy.The modified BenEzra score plays an important role in the evaluation of SLE disease activity and retinal vascular lesions.