血清神经元特异性烯醇化酶在神经精神性狼疮患儿的改变

Serum neuron specific enolase levels in children with neuropsychiatric systemic lupus erythematosus

目的探讨血清神经元特异性烯醇化酶(neuron specific enolase, NSE)水平在有神经精神症状的系统性红斑狼疮(systemic lupus erythematosus, SLE)患儿的变化,以期发现诊断神经精神狼疮(neuropsychiatric systemic lupus erythematosus, NPSLE)的生化指标。方法选择2016年1~6月北京协和医院收治的SLE患儿39例,分为NPSLE组和非NPSLE组。对比NPSLE组、非NPSLE组以及同期健康儿童(正常对照组)血清NSE的水平。结果 NPSLE组25例,男2例,女23例,平均年龄(11.6±3.0)岁;非NPSLE组14例,男2例,女12例,平均年龄(11.8±3.3)岁;正常对照组11例,男1例,女10例,平均年龄(11.2±1.3)岁。NPSLE组的神经精神症状表现为头痛12例,惊厥发作3例,认知障碍3例,急性意识紊乱2例,焦虑2例,脑血管病1例,精神病1例,脱髓鞘综合征1例。NPSLE组血清NSE为(11.8±3.0)ng/ml,明显低于非NPSLE组的(15.2±3.7)ng/ml和正常对照组的(17.9±2.6)ng/ml,差异均有统计学意义(P均<0.01)。结论血清NSE水平的降低提示NPSLE患儿神经损伤和神经组织代谢减低,血清NSE可能是一种对于NPSLE诊断和随诊有价值的血清学指标。

Objective To evaluate the serum neuron specific enolase(NSE) levels in the children with neuropsychiatric systemic lupus erythematous(NPSLE). Methods A cross-sectional study was conducted. This study comprised 39 systemic lupus erythematosus(SLE) patients and 11 healthy children from January to June 2016 in Peking Union Medical College Hospital, and the SLE patients were sub-divided into NPSLE group and non-NPSLE group. NSE serum levels were measured in the three groups. Results There were 25 cases(two males and 23 females) in NPSLE group, the average age was(11.6±3.3) years. There were 14 cases(two males and 12 females) in non-NPSLE group, the average age was(11.8±3.3) years. There were 11 cases(one male and 10 females) in the control group, the average age was(11.2±1.3) years. The clinical manifestations of NPSLE group included headache(12 cases), convulsion(three cases), cognitive impairment(three cases), acute consciousness disorder(two cases), anxiety(two cases), cerebral vascular disease(one case), mental diorder(one case) and demyelination(one case). The serum level of NSE significantly decreased in NPSLE group than that in non-NPSLE group and the control group [(11.8±3.0) ng/ml vs.(15.2±3.7) ng/ml, P < 0.01;(11.8±3.0) ng/ml vs.(17.9±2.6) ng/ml, P < 0.01]. Conclusions Decreased serum concentration of NSE may reflect declined metabolism of the nervous tissue in the patients with NPSLE. NSE may be a valuable serological indicator for NPSLE diagnosis and follow-up.