20例神经精神性狼疮患者的临床分析

Clinical study of 20 patients with neuropsychiatric systemic lupus erythematosus

目的:分析神经精神性狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)的临床特点,探讨该病发生的危险因素。方法:选取重庆医科大学附属第二医院2016年1月至2020年12月住院的20例NPSLE患者为研究组。统计分析20例NPSLE患者的神经精神症状、脑脊液、脑核磁共振、治疗方案及预后。选取同期20例系统性红斑狼疮(systemic lupus erythematosus,SLE)患者为对照组。比较2组实验室指标及研究组治疗前后实验指标。对NPSLE的相关风险因素进行logistic回归分析。结果:研究组与对照组相比,抗C1q抗体、抗ds-DNA抗体升高(P=0.001、0.005);C3、C4、血清白蛋白与血清总蛋白比值(albumin/globumin,A/G)降低(P=0.000、0.016、0.001);研究组治疗后与治疗前相比:抗C1q抗体、抗ds-DNA抗体、免疫球蛋白IgA、免疫球蛋白IgG降低(P=0.000、0.001、0.006、0.000);C3、C4、A/G升高(P=0.000、0.000、0.000)。单因素logistic回归分析提示A/G、抗ds-DNA抗体、C3、C4与NPSLE相关。多因素logistic回归分析提示C3与NPSLE相关(OR=0.000,95%CI=0.000~0.417,P=0.034)。结论:较SLE相比,NPSLE患者的C1q抗体、抗ds-DNA抗体升高,经治疗好转后其滴度下降;C3、C4、A/G降低,经治疗好转后上升。NPSLE患者的免疫球蛋白IgA、免疫球蛋白IgG经治疗好转后下降。抗C1q抗体、抗ds-DNA抗体、C3、C4、A/G、免疫球蛋白IgA、免疫球蛋白IgG与NPSLE密切相关,是反映NPSLE疾病活动度的重要指标。C3下降是NPSLE发生的独立危险因素。

Objective:To analyze the clinical characteristics of neuropsychiatric systemic lupus erythematosus(NPSLE)and explore the hazardous factor of this disease. Methods:A total of 20 NPSLE patients hospitalized in The Second Affiliated Hospital of Chongqing Medical University from January 2016 to December 2020 were taken as the research group. The neuropsychiatric symptoms,cerebrospinal fluid,brain MRI,treatment protocols and prognosis of 20 NPSLE patients were statistically analyzed. A total of 20 patients with systemic lupus erythematosus(SLE)during the same period were taken as the control group. Two sets of laboratory indicators as well as laboratory indicators before and after treatment of the research group were compared. Logistic regression analysis was performed on the related risk factors of NPSLE. Results:Compared with the control group,the anti-C1 q antibody and the anti-ds-DNA antibody of the research group increased(P =0.001,0.005);C3,C4 and serum albumin/globumin(A/G) reduced(P =0.000,0.016,0.001).Compared with anti-C1 q antibody,anti-ds-DNA antibody,immune globulin IgA and immune globulin IgG of the research group before treatment and these laboratory indicators after treatment reduced(P=0.000,0.001,0.006,0.000);C3,C4 and A/G increased(P=0.000,0.000,0.000). The univariate logistics regression analysis indicated that A/G,anti-ds-DNA antibody,C3 and C4 were related to NPSLE.The multivariate logistics regression analysis indicated that C3 was related to NPSLE(OR=0.000,95%CI=0.000-0.417,P=0.034).Conclusion:Compared with SLE,C1 q antibody and anti-ds-DNA antibody of NPSLE patients are increased,and their titer decreases after treatment;C3,C4 and A/G are decreased,and their indexes increase after treatment. The indexes of immunoglobulin IgA and immunoglobulin IgG in NPSLE patients decrease after treatment. Anti-C1 q antibody,anti-ds-DNA antibody,C3,C4,A/G,immune globulin IgA and immune globulin IgG are closely correlated with NPSLE,and they are key indicators reflecting the activity of NPSLE. Decline in C3 is an independent risk factor for NPSLE.