Tebbe B, Orfanos C E
Universitäts-Hauklinik und Poliklinik, Klinikum Steglitz, Freie Universität Berlin.
Z Hautkr. 1987 Nov 15;62(22):1563-72, 1577-8, 1583-4.
In this retrospective study, the data of 97 patients with lupus erythematosus (LE) were evaluated according to clinical and laboratory criteria. 30 patients had localized chronic discoid LE (CDLE); 44 patients showed disseminated LE lesions either of the chronic discoid or the subacute cutaneous (SCLE) type; and 23 patients had systemic LE (SLE). The mean age ranged between 21 and 50 years. The male/female ratio was 1:3 in localized LE, 1:13 in disseminated LE with general symptoms, and 1:10 in SLE. Localized LE did not, as a rule, show any general symptoms. On the other hand, 14/44 patients (= 30%) with disseminated LE revealed general symptoms such as BSR elevation, arthralgia, anemia, and leukopenia. In addition, 4/44 patients (= 9%) with disseminated skin lesions showed various extracutaneous manifestations: nephritis (2), pericarditis (2), pleuritis (2), polyarthritis (1). Arthropathy was the major clinical manifestation in SLE (18/23 patients). Immunological parameters were usually negative in localized chronic discoid LE. 7/23 patients (= 30%) with disseminated LE had elevated ANA titers; 4/26 patients (= 15%) showed increased DNA binding capacity. In 57% of the patients with disseminated LE associated with general clinical symptoms, in contrast, we found elevated ANA titers; 71 of them revealed increased DNA binding capacity. Our findings suggest that disseminated LE, especially the SCLE type, may be regarded as variant of LE which tends to transition into SLE. Moreover, ANA titers may serve as a screening method; the detection of circulating DNA antibodies, however, is considered a rather specific parameter with regard to the diagnosis of systemic manifestation.
在这项回顾性研究中，根据临床和实验室标准对97例红斑狼疮（LE）患者的数据进行了评估。30例患者患有局限性慢性盘状红斑狼疮（CDLE）；44例患者表现为慢性盘状或亚急性皮肤型（SCLE）的播散性LE病变；23例患者患有系统性红斑狼疮（SLE）。平均年龄在21至50岁之间。局限性LE的男女比例为1:3，有全身症状的播散性LE为1:13，SLE为1:10。局限性LE通常不表现出任何全身症状。另一方面，44例播散性LE患者中有14例（=30%）出现全身症状，如血沉升高、关节痛、贫血和白细胞减少。此外，44例有播散性皮肤病变的患者中有4例（=9%）表现出各种皮肤外表现：肾炎（2例）、心包炎（2例）、胸膜炎（2例）、多关节炎（1例）。关节病是SLE的主要临床表现（23例患者中有18例）。局限性慢性盘状LE的免疫参数通常为阴性。23例播散性LE患者中有7例（=30%）抗核抗体（ANA）滴度升高；26例患者中有4例（=15%）显示DNA结合能力增加。相比之下，在57%有全身临床症状的播散性LE患者中，我们发现ANA滴度升高；其中71例显示DNA结合能力增加。我们的研究结果表明，播散性LE，尤其是SCLE型，可能被视为LE的一种变体，倾向于转变为SLE。此外，ANA滴度可作为一种筛查方法；然而，循环DNA抗体的检测被认为是诊断全身表现的一个相当特异的参数。
