Gao N, Li M T, Li Y H, Zhang S H, Dai R P, Zhang S Z, Zhao L D, Wang L, Zhang F C, Zhao Y, Zeng X F
1 Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
2 Department of Rheumatology, No.323 PLA Hospital, Xi'an, China.
Lupus. 2017 Oct;26(11):1182-1189. doi: 10.1177/0961203317698050. Epub 2017 Mar 29.
A retrospective case control study was conducted in the Peking Union Medical College Hospital. Medical records were reviewed for demographic data, clinical features, laboratory results, systemic lupus erythematosus (SLE) disease activity evaluations, and ophthalmic examinations to investigate the clinical characteristics and significance of retinal vasculopathy (RV) in Chinese patients with systemic lupus erythematosus. The prevalence of RV was approximately 0.66% (35/5298) in SLE patients. A total of 60 eyes were involved. The ocular presentations included decrease of visual acuity (48/60, 80%), visual field loss (7/60, 11.7%), and diplopia (3/60, 5%). Ophthalmic fundoscopic examination revealed cotton-wool spots (30/60, 50%), retinal vascular attenuation (31/60, 51.6%), and hemorrhages (41/60, 68.3%). Retinal angiogram showed that 72.7% (16/22) eyes had vaso-occlusion. The ophthalmic episodes could occur at any stage of SLE duration, with a median of 12 months (0-168 months) following SLE onset. Twenty-one (35%) eyes did not recover, or even worsened, during hospital stay. RV was found to be significantly associated with neuropsychiatric lesions (51.4% vs. 21.3%, p = .005) and hematological disturbance (62.9% vs. 34.3%, p = .005). SLE patients with RV had significantly higher SLE disease activity index scores than controls (19.9 ± 0.9 vs. 10.2 ± 0.7, p < .001). An inverse association of anti-SSA antibody with RV was detected (34.3% vs. 67.1%, p = .001). Nervous system disturbance (odds ratio (OR) = 4.340, 95% confidence interval (CI) 1.438, 13.094, p = .009) and leukocytopenia (OR = 6.385, 95% CI 1.916, 21.278, p = .003) were independent risk factors, while anti-SSA antibody positivity (OR = 0.249, 95% CI 0.087, 0.710, p = .009) was a protective factor for RV in SLE patients. In certain cases, RV is a threatening condition for SLE patients presenting with clinical ocular manifestations. Ophthalmo-fundoscopic detection is recommended as soon as SLE is diagnosed.
在北京协和医院进行了一项回顾性病例对照研究。查阅病历以获取人口统计学数据、临床特征、实验室检查结果、系统性红斑狼疮（SLE）疾病活动评估以及眼科检查结果，以调查中国系统性红斑狼疮患者视网膜血管病变（RV）的临床特征及意义。SLE患者中RV的患病率约为0.66%（35/5298）。共累及60只眼。眼部表现包括视力下降（48/60，80%）、视野缺损（7/60，11.7%）和复视（3/60，5%）。眼底镜检查发现棉絮斑（30/60，50%）、视网膜血管变细（31/60，51.6%）和出血（41/60，68.3%）。视网膜血管造影显示72.7%（16/22）的眼有血管阻塞。眼部病变可发生在SLE病程的任何阶段，SLE发病后中位时间为12个月（0 - 168个月）。21只（35%）眼在住院期间未恢复甚至病情加重。发现RV与神经精神性病变（51.4%对21.3%，p = 0.005）和血液系统紊乱（62.9%对34.3%，p = 0.005）显著相关。患有RV的SLE患者的SLE疾病活动指数评分显著高于对照组（19.9±0.9对10.2±0.7，p < 0.001）。检测到抗SSA抗体与RV呈负相关（34.3%对67.1%，p = 0.001）。神经系统紊乱（比值比（OR）= 4.340，95%置信区间（CI）1.438，13.094，p = 0.009）和白细胞减少（OR = 6.385，95% CI 1.916，21.278，p = 0.003）是独立危险因素，而抗SSA抗体阳性（OR = 0.249，95% CI 0.087，0.710，p = 0.009）是SLE患者RV的保护因素。在某些情况下，RV对出现临床眼部表现的SLE患者是一种威胁性状况。建议在诊断SLE后尽快进行眼底镜检查。
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