CAJ | 학술논문

目的探讨儿童和成人系统性红斑狼疮(SLE)临床特点的差异.方法回顾性分析89例住院儿童SLE和随机选取同期住院的120例成人SLE患者的临床资料,分析比较2组患者的临床表现、实验室检查结果、肾脏病理分型和疾病活动.结果发热、皮疹、关节炎、肾脏损害和贫血为儿童和成人SLE最常见的临床表现,儿童SLE发热、肝脾淋巴结大、贫血、肾脏损害、消化系统损害和神经系统损害的发生率均高于成人SLE,差异均有统计学意义(x2=5.085,P=0.024;x2=6.027,P=0.014;x2=4.261,P=0.039;x2=4.221,P=0.040;x2=4.566,P=0.033;x2=4.346,P=0.037).免疫学指标结果显示,儿童SLE血清抗双链DNA抗体阳性率高于成人SLE,差异有统计学意义(x2=1.895,P=0.169).其血清抗心磷脂抗体阳性率低于成人SLE,差异有统计学意义(x2 =4.823,P=0.028);其血清补体C3、C4水平均低于成人SLE,差异均有统计学意义(x2=4.221,P=0.040;x2=7.977,P=0.004).肾脏病理分型中以Ⅲ型和Ⅳ型最为常见,儿童SLE肾脏损害更为严重,其Ⅳ型的发生率高于成人SLE,差异有统计学意义(x2=4.128,P=0.042);SLE疾病活动以中度最为常见,儿童SLE疾病活动指数评分高于成人SLE,差异有统计学意义(=2.192,P=0.031).结论儿童与成人SLE的临床特点存在差异,儿童SLE疾病活动性更强,更易发生多系统损害,而且肾脏病变较严重,需早期诊断、积极治疗.
목적 탐토인동화성인계통성홍반랑창(SLE)림상특점적차이.방법 회고성분석89례주원인동SLE화수궤선취동기주원적120례성인SLE환자적림상자료,분석비교2조환자적림상표현、실험실검사결과、신장병리분형화질병활동.결과 발열、피진、관절염、신장손해화빈혈위인동화성인SLE최상견적림상표현,인동SLE발열、간비림파결대、빈혈、신장손해、소화계통손해화신경계통손해적발생솔균고우성인SLE,차이균유통계학의의(x2=5.085,P=0.024;x2=6.027,P=0.014;x2=4.261,P=0.039;x2=4.221,P=0.040;x2=4.566,P=0.033;x2=4.346,P=0.037).면역학지표결과현시,인동SLE혈청항쌍련DNA항체양성솔고우성인SLE,차이유통계학의의(x2=1.895,P=0.169).기혈청항심린지항체양성솔저우성인SLE,차이유통계학의의(x2 =4.823,P=0.028);기혈청보체C3、C4수평균저우성인SLE,차이균유통계학의의(x2=4.221,P=0.040;x2=7.977,P=0.004).신장병리분형중이Ⅲ형화Ⅳ형최위상견,인동SLE신장손해경위엄중,기Ⅳ형적발생솔고우성인SLE,차이유통계학의의(x2=4.128,P=0.042);SLE질병활동이중도최위상견,인동SLE질병활동지수평분고우성인SLE,차이유통계학의의(=2.192,P=0.031).결론 인동여성인SLE적림상특점존재차이,인동SLE질병활동성경강,경역발생다계통손해,이차신장병변교엄중,수조기진단、적겁치료.
Objective To investigate the differences in clinical characteristics between children and adults with systemic lupus erythematosus (SLE).Methods A retrospective cohort study was performed to investigate the differences in clinical data from 89 children and 120 adults with SLE.Clinical manifestations,laboratory results,renal pathological changes and disease activities of patients from the 2 groups were evaluated.Results The most common clinical manifestations including fever,rash,arthritis,renal damage and anemia were found in both groups.However,the incidences of symptoms such as fever,lymphadenectasis,anemia,renal damage,damage of digestive system and nerve system were higher in children with SLE than those in adult patients,and there were statistical significances (x2 =5.085,P=0.024;x2 =6.027,P =0.014;X2 =4.261,P =0.039;x2 =4.221,P =0.040;x2 =4.566,P =0.033;,x2 =4.346,P =0.037,respectively).The positive rate of antibodies against double stranded DNA in serum of children with SLE was higher than that in adults (x2 =1.895,P =0.169).However,the positive rate of antibodies against cardiolipin in serum of children with SLE was lower than that in adults,and there was statistical significance (x2 =4.823,P =0.028).Complement C3 and C4 levels in serum of children with SLE were lower than those in group of adults,and there were statistical significance (x2 =4.221,P =0.040;x2 =7.977,P =0.004,respectively).Class Ⅲ and Ⅳ were commonly observed in classification of renal pathological examinations in both groups.But it was shown that the prevalence of renal damage in children with SLE was higher than that in adult patients,and there was statistical significance (x2 =4.128,P =0.042).The most common SLE disease activity was identified as moderate in the both groups.However,the score of SLE Disease Activity Index was higher in children with SLE than that in adults,there was statistical significance (t =2.192,P =0.031).Conclusions Differences in clinical characteristics of SLE were found in children and adults.Compared with adults with SLE,children patients were found to show higher prevalence of disease activities,damage of multisystem and renal damage.Therefore,children with SLE need to be diagnosed as early as possible and treated aggressively.