原发性干燥综合征患者合并周围神经病变的临床及实验室特点分析

Clinical and laboratory analysis of primary Sjogren′s syndrome complicated with neurological lesions

目的 :了解原发性干燥综合征(primary Sj觟gren's syndrome, p SS)患者合并周围神经(peripheral nervous system)病变的临床特点,探讨pSS合并周围神经病变的危险因素。方法:回顾性分析2015年1月至2017年9月,同济大学附属同济医院风湿免疫科收治且符合2002年美欧协作组提出的干燥综合征分类标准的132例p SS患者。通过临床症状、神经系统查体及肌电图检查明确患者有无神经系统损害,进而将其分为p SS合并周围神经系统病变(primary Sj觟gren's syndrome with peripheral nervous system, pSS-PNS)组与未合并周围神经系统病变(primary Sj觟gren's syndrome not with peripheral nervous system, p SS-n PNS)组,并比较2组的临床表现、相应检查、实验室特征。结果 :132例p SS患者中男性12例,女性120例,男女之比为1∶10,其中21例患者合并有周围神经系统受累(21/132,15.9%),p SS-PNS与pSS-nPNS组间的性别构成、年龄、起病年龄及病程差异无统计学意义。与pSS-nPNS相比,p SS-PNS组的关节肿痛较为常见(71.4%比44.1%,P=0.02),且CD8水平明显下降[(21.25±13.11)%与(26.65±9.44)%,P=0.02],CD4/CD8比值明显升高(2.80±1.45比1.91±1.12,P=0.04)。pSS-PNS组的欧洲抗风湿病联盟干燥综合征疾病活动度指数(European League Against Rheumatism Sj觟gren′s Syndrome Disease Activity Index,ESSDAI)较p SS-n PNS组明显增高[(4.71±0.46)分比(2.80±0.17)分,P<0.001],且ESSDAI(OR=1.836,95%CI 1.169～2.883,P=0.008)是pSS合并周围神经病变的独立危险因素。结论:pSS-PNS患者的临床表现多样,疾病活动度高,高疾病活动度为p SS-PNS的独立危险因素。

Objective:To investigate the clinical manifestations,electromyographic abnormalities and laboratory characteristics of primary Sj?gren’s syndrome(pSS)complicated with peripheral neuropathy and to analyze the risk factor of pSS complicated with peripheral neuropathy.Methods:A retrospective analysis was performed on 132 pSS patients who met the 2002 American-European Consensus Group criteria for pSS at Tongji Hospital from January 2015 to September2017.The patients were categorized into group with peripheral neuropathy(pSS-PNS)and group without peripheral neuropathy(pSS-n PNS).The clinical manifestations,corresponding examinations and laboratory characteristics of the two groups were compared.The data were analyzed by t test,χ~2test and logistic regression analysis.Results:A total of 132patients with p SS were enrolled in this study,including 12 males and 120 females.The ratio of male to female was 1∶10.Among them,21 patients suffered from peripheral nervous system involvement and the prevalence rate was 15.9%(21/132).There were no significant differences in gender composition,age,onset age and course between the two groups.Compared with the group without peripheral neuropathy,joint swelling and pain(71.4%and 44.1%,P=0.02)were more common in the group with peripheral neuropathy,and CD8[(21.25±13.11)%and(26.65±9.44)%,P=0.02]decreased significantly,ratio of CD4/CD8(2.80±1.45 vs 1.91±1.12,P=0.04)increased significantly.ESSDAI(European League Against Rheumatism Sj?gren’s Syndrome Disease Activity Index)score[(4.71±0.46)and(2.80±0.17)]was significantly higher in p SS-PNS group.ESSDAI(OR=1.836,95%CI 1.169-2.883,P=0.008)was an independent risk factor for pSS with peripheral neuropathy.Conclusions:The clinical manifestations of pSS complicated with peripheral neuropathy are diverse,and the disease activity is high.High disease activity is an independent risk factor for Sj?gren’s syndrome complicated with peripheral neuropathy.