神经精神狼疮患者临床表现及免疫学特点分析

发布时间：2018-02-13 19:29

本文关键词： 神经精神狼疮临床表现免疫学危险因素脑电图　出处：《宁夏医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨神经精神性狼疮患者临床表现、实验室及免疫学检查特点。方法回顾分析2011年2月-2014年2月在宁夏医科大学总医院住院并确诊为神经精神狼疮患者124例(为NPSLE组),同期住院诊断为系统性红斑狼疮且不伴有神经精神症状患者94例(SLE组),分析2组患者实验室检查结果的差异性。结果1.SLE患者神经精神症状多出现在病程早期,最常见的临床症状为关节炎和皮疹;2.NPSLE组患者的病程明显小于SLE组患者(Z=-2.516,P=0.012),而性别及系统累及情况无统计学差异(P0.05);3.NPSLE组患者比SLE组患者更易出现皮疹、口腔溃疡和光过敏(χ2=9.266,P=0.002;χ2=5.298,P=0.030;χ2=7.694,P=0.004);4.NPSLE组患者中大部分同时或相继出现2种或2种以上神经精神症状,最常见的症状为头痛;5.NPSLE组患者血清中的血小板比SLE组患者低(t=-5.416,P=0.000),而谷丙转氨酶、谷草转氨酶、肌酸激酶较SLE组患者相比明显升高(Z=-3.283,P=0.001;Z=-4.561,P=0.000;Z=-4.300,P=0.000),但血白细胞、红细胞、血红蛋白、肌酐、白蛋白、血脂等实验室指标无明显差异性(P0.05);6.NPSLE组患者血清中免疫球蛋白M较SLE组患者相比明显升高(Z=-2.471,P=0.013),补体C4较SLE组患者明显降低(Z=-3.006,P=0.003),两组患者抗-Rib抗体阳性率有明显统计学意义(χ2=4.947,P=0.026),而血沉、CRP、抗-ds DNA抗体、抗磷脂抗体、补体C3,免疫球蛋白G、A、Hep2-ANA等免疫学指标无明显差异性(P0.05);7.Spearman相关分析可见:抗ds-DNA抗体与病程、补体C4呈负相关,相关系数分别为(r=-0.331,P=0.000)、(r=-0.332,P=0.000),脑电图的异常程度与补体C4呈负相关(r=-0.252,P=0.012),补体C4水平与病程呈正相关(r=0.249,P=0.006);8.采用Logistics回归分析可见,抗-Rib抗体、血小板计数、皮疹和血清Ig M含量为NPSLE的危险因素,其中,抗-Rib抗体阳性是发生NPSLE的独立危险因素(OR=4.276,95%CI=1.631,11.207);9.大多数神经精神狼疮患者脑电图有改变,主要呈弥漫性损伤,最常发生的病变区域为额区,最常发生改变的脑电波为θ波;10.采用受试工作者曲线分析可见,脑电图的异常程度及出现异常的脑电波数对于诊断神经精神狼疮有一定的价值。其中,出现异常的脑电波个数的最佳临界值为α波出现异常,敏感度为64.8%,特异度为77.6%,出脑电图异常程度的最佳临界值为广泛轻度异常改变,敏感度为52.4%,特异度为86.9%。结论1.神经精神狼疮患者易出现在病程早期;2.NPSLE患者常合并其他系统损害,最常见的神经系统外临床表现为关节炎和皮疹;3.抗Rib抗体阳性是发生NPSLE的危险因素之一;4.脑电图异常程度比脑电波异常个数对预测神经精神狼疮的发生更有临床意义,联合监测患者免疫学指标和脑电图改变或能提高临床诊断。
[Abstract]:Objective to investigate the clinical manifestations of neuropsychiatric lupus. Methods from February 2011 to February 2014, 124 patients with neuropsychiatric lupus were diagnosed in Ningxia Medical University General Hospital (NPSLE group) and were diagnosed as systemic erythematosus in the same period. There were 94 patients with SLE without neuropsychiatric symptoms. The differences of laboratory findings between the two groups were analyzed. 1. The neuropsychiatric symptoms of SLE patients appeared in the early stage of the disease. The most common clinical symptoms were arthritis and rash. 2. The course of disease in NPSLE group was significantly smaller than that in SLE group. However, there was no significant difference in sex and systemic involvement. 3. The patients in NPSLE group were more likely to develop rash than those in SLE group. Oral ulcers and light hypersensitivity (蠂 ~ 2 ~ 2 ~ (9.266) P ~ + 0.002; 蠂 ~ 2 ~ 2 ~ (5.298) P ~ (0.030); 蠂 ~ (2) 7.694 ~ (0.004) P ~ (0.004)). Most of the patients in NPSLE group have two or more neuropsychiatric symptoms at the same time or one after another. The most common symptom is that the platelets in serum of patients with SLE are lower than those of patients with SLE, and the levels of glutamate-pyruvic aminotransferase, aspartate aminotransferase and aspartate aminotransferase are lower than those in SLE group. Creatine kinase (CK) was significantly higher than that in SLE group (P < 0.05), but the levels of serum leukocytes, erythrocytes, hemoglobin, creatinine, albumin, serum albumin were significantly higher than those in the SLE group, and the levels of creatine kinase were significantly higher than those in the SLE group, and the levels of creatine kinase were significantly higher than those in the SLE group. Serum immunoglobulin M in patients with SLE was significantly higher than that in patients with SLE. Complement C4 was significantly lower than that in patients with SLE. The positive rate of anti-Rib antibody in both groups was significantly higher than that in patients with SLE. The positive rate of serum immunoglobulin M in patients with NPSLE was significantly higher than that in patients with SLE. The positive rate of serum immunoglobulin M in patients with NPSLE was significantly higher than that in patients with SLE. The positive rate of anti-Rib antibody in the two groups was significantly higher than that in the patients with SLE. (蠂 2 / 4.947) and erythrocyte sedimentation rate (ESR), anti-DS DNA antibody, The correlation analysis of anti-phospholipid antibody, complement C _ 3 and immunoglobulin G _ (2) Agna Hep2-ANA showed that the anti-phospholipid antibody was negatively correlated with the course of disease and complement C _ 4, and there was no significant difference in the correlation between anti-phospholipid antibody and complement C _ 4. The correlation coefficient was 0.331P0. 000, the abnormal degree of EEG was negatively correlated with complement C4, and the level of complement C4 was positively correlated with the course of disease. Logistics regression analysis showed that anti-Rib antibody, platelet count, rash and serum IgM were risk factors of NPSLE. The positive anti-Rib antibody was an independent risk factor for NPSLE. The most common change of EEG is 胃 wave 10. The abnormal degree of EEG and the number of abnormal EEG are valuable for the diagnosis of neuropsychiatric lupus. The best critical value for the number of abnormal EEG waves is the abnormal alpha wave, the sensitivity is 64.8, the specificity is 77.6. the best critical value of abnormal EEG is a wide range of mild abnormal changes. The sensitivity is 52.4 and the specificity is 86.9. Conclusion 1. Patients with neuropsychiatric lupus are prone to occur in the early stage of the disease. 2. NPSLE patients are often associated with other system damage. 2. The most common external clinical manifestations of the nervous system are arthritis and rash 3.The positive Rib antibody is one of the risk factors for the occurrence of NPSLE 4.The degree of abnormal EEG is more important than the number of abnormal EEG in predicting the occurrence of neuropsychiatric lupus. Combined monitoring of immunological parameters and EEG may improve clinical diagnosis.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.241

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