颅内外血栓在系统性红斑狼疮患儿中的发生情况比较

Comparison between incidence of intracranial thr ombosis and extracranial thrombosis in children with systemic lupus erythematosus

目的通过回顾性比较儿童系统性红斑狼疮(SLE)患者发生颅内、外血栓的情况,旨在发现SLE合并不同部位血栓的危险因素。方法选取2006年1月—2019年12月首都医科大学附属北京儿童医院收治的SLE患儿,收集患儿人口学资料、临床表现、活动度评估及治疗、病程及随访资料等,并收集实验室检查数据及血栓相关数据等,根据血栓部位将患儿分为颅内血栓组及颅外血栓组,对两组资料进行比较。结果27例SLE合并血栓患儿中,6例(22.22%)发生颅内血栓,21例(77.78%)患儿发生颅外血栓。颅内血栓以颅内静脉窦血栓形成(CVST)更为多见,横窦是CVST最常见的受累部位。颅外血栓常见受累部位依次为股总静脉、髂外静脉及股深浅静脉。颅外血栓组合并肾脏受累比例较颅内血栓组高(P<0.05),颅内血栓组合并神经系统受累比例较颅外血栓组高(P<0.05)。颅外血栓组的Hb、C3、C4水平较颅内血栓组低,尿蛋白水平较颅内血栓组高(P<0.05)。治疗后两组血栓均有一定程度的好转,其中颅内血栓组1例(16.7%)患儿血栓消失再通,颅外血栓组11例(52.4%)患儿血栓消失再通。结论SLE合并颅内、外血栓形成有不同的特点,神经系统症状是颅内血栓最常见的症状,肾脏受累的患儿更易发生颅外血栓。早期诊断,积极治疗可明显改善SLE合并血栓患儿的预后。

Objective To find the risk factors for thrombosis in different location by comparing the occurrence of intracranial and extracranial thrombosis in children with cSLE.Methods Demographic data,clinical manifestations,activity assessment,treatment,course of disease,and follow-up data of the cSLE patients who meeting the inclusion criteria were collected.Laboratory examination data and thrombotic data were collected.The cSLE patients were divided into intracranial thrombus group and extracranial thrombus group according to the location of the thrombus.All the data mentioned above in two groups were compared.SPSS 25 was used for statistical analysis.Results Among the 27 cSLE patients complicated with thrombus,intracranial thrombosis occurred in 6 cases(22.22%)and extracranial thrombosis in 21 cases(77.78%).Cerebral Venous Sinus Thrombosis(CVST)was more common in intracranial thrombosis group,and transverse sinus was the most common site of CVST.The common sites of extracranial thrombus were femoral vein,external iliac vein and superficial femoral vein.Renal involvement in the extracranial thrombus group was significantly higher than that in the intracranial thrombus group(P<0.05).Nervous system involvement in the intracranial thrombus group was significantly higher than that in the extracranial thrombus group(P<0.05).The hemoglobin level,C3 and C4 levels in extracranial thrombus group were significantly lower than those in intracranial thrombus group,and the urine protein level was significantly higher than that in the intracranial thrombus group(P<0.05).After anticoagulant therapy,1 case(16.7%)in intracranial thrombus group and 11 cases(52.4%)in extracranial thrombus group underwent thrombolysis and got recanalization.Conclusion The characteristics between intracranial thrombus group and extracranial thrombus group are different in cSLE patients.Neurological symptoms are the most common symptoms of intracranial thrombus group.CSLE patients with renal involvement are more likely to have extracranial thrombosis.Early diagnosis and active treatment can significantly improve the prognosis of cSLE complicated with thrombosis.