CAJ | 학술논문

目的探讨系统性红斑狼疮(SLE)外周神经病(PN)的发病率及其临床特点,以便早期发现及治疗,提高患者生活质量.方法北京协和医院1995年1月至2011年8月间住院的SLE相关PN(SLE-PN)患者共67例,对其临床特点及预后进行回顾性分析,并与应用等距抽样法抽取的201例同时期无SLE相关PN患者进行对比分析.统计学处理采用x2检验、t检验和Mann-Whitney检验.结果 SLE患者PN的患病率是1.5％(67/4514).共发生72例次PN,5例次(7.5％)患者同时存在2种类型的PN.7种类型PN中,以多神经病最为常见(45例次,62.5％),其次是单神经病(9例次,12.5％)、重症肌无力(8例次,11.1％)、颅神经病(7例次,9.7％)、自主神经病(2例次,2.8％)及吉兰巴雷综合征(1例次,1.4％),未见神经丛病.PN的临床表现以相应部位的肌无力及麻木(37例次,51.4％)最为常见,而6.9％(5例次)PN并无PN的相应临床表现,为神经电生理检查发现.随诊0.3～124个月,平均(6±17)个月,大多数PN(51例次,70.8％)经过治疗症状能够减轻.SLE-PN的患者与无SLE相关PN的患者在年龄[(37±14)岁与(32±14)岁,P＜0.05],发热[44例(65.7％)与96例(47.8％),P＜0.05],肌炎[12例(17.9％)与10例(5.0％),P＜0.01],皮肤黏膜[54例(80.6％)与120例(59.7％),P＜0.01],中枢神经系统受累[26例(38.8％)与40例(19.9％),P＜0.01],消化系统受累[4例(6.0％)与37例(18.4％),P＜0.05],抗Sm抗体阳性[34.4％(22/64)与18.6％(33/177),P＜0.05],抗RNP抗体阳性[46.9％(30/64)与29.9％(53/177),P＜0.05],IgG升高[52.4％(33/63)与30.1％(44/146),P＜0.01],SLEDAI评分[12.0(9.0)与9.5(10.8),P＜0.05]上差异有统计学意义.结论 SLE-PN并不罕见,病情相对较活跃,易出现发热、中枢神经系统、皮肤黏膜及肌炎表现.多科协作综合治疗,有助于改善症状、提高生活质量.
목적 탐토계통성홍반랑창(SLE)외주신경병(PN)적발병솔급기림상특점,이편조기발현급치료,제고환자생활질량.방법 북경협화의원1995년1월지2011년8월간주원적SLE상관PN(SLE-PN)환자공67례,대기림상특점급예후진행회고성분석,병여응용등거추양법추취적201례동시기무SLE상관PN환자진행대비분석.통계학처리채용x2검험、t검험화Mann-Whitney검험.결과 SLE환자PN적환병솔시1.5％(67/4514).공발생72례차PN,5례차(7.5％)환자동시존재2충류형적PN.7충류형PN중,이다신경병최위상견(45례차,62.5％),기차시단신경병(9례차,12.5％)、중증기무력(8례차,11.1％)、로신경병(7례차,9.7％)、자주신경병(2례차,2.8％)급길란파뢰종합정(1례차,1.4％),미견신경총병.PN적림상표현이상응부위적기무력급마목(37례차,51.4％)최위상견,이6.9％(5례차)PN병무PN적상응림상표현,위신경전생리검사발현.수진0.3～124개월,평균(6±17)개월,대다수PN(51례차,70.8％)경과치료증상능구감경.SLE-PN적환자여무SLE상관PN적환자재년령[(37±14)세여(32±14)세,P＜0.05],발열[44례(65.7％)여96례(47.8％),P＜0.05],기염[12례(17.9％)여10례(5.0％),P＜0.01],피부점막[54례(80.6％)여120례(59.7％),P＜0.01],중추신경계통수루[26례(38.8％)여40례(19.9％),P＜0.01],소화계통수루[4례(6.0％)여37례(18.4％),P＜0.05],항Sm항체양성[34.4％(22/64)여18.6％(33/177),P＜0.05],항RNP항체양성[46.9％(30/64)여29.9％(53/177),P＜0.05],IgG승고[52.4％(33/63)여30.1％(44/146),P＜0.01],SLEDAI평분[12.0(9.0)여9.5(10.8),P＜0.05]상차이유통계학의의.결론 SLE-PN병불한견,병정상대교활약,역출현발열、중추신경계통、피부점막급기염표현.다과협작종합치료,유조우개선증상、제고생활질량.
Objective To investigate the frequence and clinical characteristics of peripheral neuropathy (PN) of patients with systemic lupus erythematosus (SLE) in China.Methods The data of 67 consecutive PN related with SLE (SLE-PN) patients admitted to Peking Union Medical College Hospital (PUMCH) during January 1995 to August 2011 were retrospectively analyzed.At the same time,a total of 201 cases were randomly selected as controls from 4447 SLE patients without SLE-PN in PUMCH during the same period.Chi-square test,t test and Mann-Whitney test were used for statistical analysis.Results The prevalence of SLE-PN in SLE patients was 1.5％(67/4514).Seventy-two cases of PN were discovered in 67 patients.Polyneuropathy was the most frequent presentation and was diagnosed in 45 cases(62.5％),mononeuropathy in 9 cases (12.5％),myasthenia gravis in 8 cases (11.1％),cranial neuropathy in 7 cases (9.7％),autonomic disorder in 2 cases (2.8％) and acute inflammatory demyelinating polyradiculoneuropathy in 1 case (1.4％).No plexopathy was diagnosed.No symptoms were observed in 5 cases (6.9％) PN.There were differences between SLE patients with and without SLE-PN in age[(37±14) years vs (32±14) years,P＜0.05],fever(65.7％ vs 47.8％,P＜0.05),myositis (17.9％ vs 5.0％,P＜0.01),skin and mucous involvement of skin and mucous (80.6％ vs 59.7％,P＜0.01),central nervous system involvement (38.8％ vs 19.9％,P＜0.01),gastrointestinal involvement (6.0％ vs 18.4％,P＜0.05),anti-Sm antibody positivity (34.4％ vs 18.6％,P＜0.05),anti-RNP antibody positivity (46.9％ vs 29.9％,P＜0.05),elevation of IgG (52.4％ vs 30.1％,P＜0.01),and SLEDAI score [12.0(9.0) vs 9.5(10.8),P＜0.05].Conclusion SLE-PN is not rare in patients with SLE.SLE patients with peripheral neuropathy tend to have more active disease.Multidisciplinary collaboration and comprehensive treatment can help to relieve pain and improve the quality of life.