男性儿童与成人系统性红斑狼疮的临床分析

摘要

目的：探讨男性儿童与成人系统性红斑狼疮（ SLE）患者临床表现及实验室检测结果的差异性。方法选取宁夏医科大学总医院风湿免疫科2004年1月—2014年12月住院的150例男性SLE患者，其中儿童30例，成人120例。记录患者起病时及进展期的临床表现，包括：蝶形红斑、盘状红斑、消化系统受累、其他皮损、口腔溃疡、关节及肌肉受损、血管炎、血液系统受损、肾脏受累、光过敏、发热／疲劳、口干／眼干、心脏受累、雷诺现象、脱发。实验室检测指标包括：红细胞沉降率、血细胞、超敏C反应蛋白（ hs-CRP）、肝功能、抗核抗体（ ANA）、可溶性核蛋白抗体（抗Sm、 SSA、 SSB、 U1RNP、 Rib抗体）、抗脱氧核糖核酸抗体（抗ds-DNA抗体）、抗心磷脂抗体（ ACA）、抗中性粒细胞胞质抗体（ ANCA）、 C3、 C4、 IgG、 IgA及IgM。结果 SLE患者起病时儿童血管炎发生率、血液系统受损发生率、肾脏受累发生率、心脏受累发生率均高于成人（ P＜0.05）；起病时其余临床表现比较，差异无统计学意义（ P＞0.05）。 SLE患者进展期儿童消化系统受累发生率、关节及肌肉受损发生率、肾脏受累发生率、发热／疲劳发生率均低于成人（P＜0.05）；进展期其余临床表现比较，差异无统计学意义（P＞0.05）。 SLE患者中儿童ANA临界阳性率、抗SSA抗体阳性率均高于成人（P＜0.05）；其余实验室检测指标比较，差异无统计学意义（P＞0.05）。男性儿童与成人SLE患者C3、 C4、 IgG、 IgA、 IgM水平比较，差异均无统计学意义（ P＞0.05）。结论男性儿童SLE患者血管炎、肾脏受累发生率较高；男性儿童SLE患者出现ANA临界阳性或抗SSA抗体阳性时均应高度警惕SLE的可能性。%Objective To explore the difference of the clinical manifestation and laboratory results of systemic lupus erythematosus ( SLE) between male children and adults.Methods A total of 150 male SLE patients ( 30 children and 120 adults) hospitalized in the Rheumatism Immunity Department of General Hospital Affilited to Ningxia Medical University from January 2004 to December 2014 were enrolled.The clinical manifestations of onset and progressive stage were recorded, including butterfly erythema, discoid rash, digestive system involvement, other skin lesion, dental ulcer, the damaging of joint and muscle, vasculitis, the damaging of blood system, kidney involvement, photosensitization, fever and fatigue, dry mouth and dry eye, cardiac involvement, Raynaud′s phenomenon and alopecia.The laboratory detection indexes included erythrocyte sedimentation rate, hemocyte, high sensitivity C-reactive protein ( hs-CRP) , liver function, antinuclear antibodies ( ANA) , soluble nucleoprotein antibodiessolubility ( anti Sm, SSA, SSB, U1RNP, Rib antibody), antideoxyribonucleic acid antibody ( anti ds-DNA ) , anticardiolipin antibody ( ACA ) , antineutrophil cytoplasmic antibody ( ANCA ) , C3 , C4 , IgG, IgA and IgM.Results The occurrence rates of vasculitis, the damaging of blood system, kidney involvement and cardiac involvement of children with SLE at onset were higher than those of adults with SLE (P<0.05), and no significant differences existed in other clinical manifestations at onset ( P>0.05 ) .The occurrence rates of digestive system involvement, the damaging of joint and muscle, kidney involvement, fever and fatigue of children with SLE in progressive stage was lower than those of adults with SLE (P<0.05), and no significant differences existed in other clinical manifestations in progressive stage (P>0.05) .The critical positive rate of ANA and the positive rate of anti-SSA antibody of children with SLE were higher than those of adults with SLE (P<0.05), and no significant differences existed in other laboratory indexes (P>0.05) .The levels of C3, C4, IgG, IgA and IgM between male children and adults with SLE were not significantly different ( P>0.05 ) .Conclusion The occurrence rates of vasculitis and kidney involvement of male children are high.The possibility of SLE should be considered when ANA or SSA of male children with SLE is critically positive.