Zheng Jiaman, Zhang Jiayu, Jin Ying, Wang Yang, Xu Liying, Zheng Hui, Jiang Haishan, Yuan Chao
Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China.
Second Clinical Medical College, Southern Medical University, Guangzhou, 510515, China.
J Neurol. 2023 Nov;270(11):5527-5535. doi: 10.1007/s00415-023-11883-z. Epub 2023 Jul 31.
The aim of this study is to investigate potential risk factors associated with peripheral nervous system lesions in primary Sjögren's syndrome (pSS) through a retrospective analysis of clinical manifestations, examination characteristics, and clinical electrophysiological features.
A retrospective case-control study was conducted at Nanfang Hospital, including 108 patients diagnosed with pSS following the criteria revised by the American College of Rheumatology in 2016. The study spanned from January 2015 to October 2020. The patient cohort was divided into two groups, an experimental group (N = 27) consisting of patients with primary Sjögren's syndrome-peripheral nervous system lesions (pSS-PNS), and a control group (N = 81) comprising patients without peripheral neurological impairment, i.e., primary Sjögren's syndrome-non peripheral nervous system lesions (pSS-nPNS).
The results showed a significant correlation between immunoglobulin G (IgG), α-Fodrin immunoglobulin G (α-FIgG), platelet counts (PLT), dry mouth and peripheral neuropathy of Sjogren's syndrome (p < 0.01). The research also revealed that α-FIgG (OR 2.03; 95% CI 1.14-3.64), IgG (OR 1.23; 95% CI 1.06-1.42), and PLT (OR 1.01; 95% CI 1.00-1.01) were identified as risk factors for the onset of peripheral neuropathy of Sjogren's syndrome, while dry mouth had a negative correlation (OR 0.08; 95% CI 0.02-0.40). Remarkably, the total risk assessment of the independent variables demonstrated a high AUC (95%CI) of 0.923 (0.861-0.986; p < 0.001), indicating an excellent prediction of pSS-PNS occurrence through the ROC analysis. Additionally, high platelet counts and strong positive anti-SSB antibody titer were found to be risk factors for dual motor and sensory nerve damages among pSS-PNS patients.
IgG, α-FIgG, and PLT were identified as independent risk factors for patients with pSS-PNS. The likelihood of peripheral neuropathy appeared to increase in tandem with the elevated levels of above three factors. Interestingly, we found that dry mouth might play a protective role in this context. Our study further noted that both high platelet counts and strong positive anti-SSB antibody titer may be associated with increased risk of both motor and sensory nerve involvement in pSS-PNS patients. These findings have significant implications for both the etiologies and therapeutics of pSS-PNS.
本研究旨在通过回顾性分析原发性干燥综合征（pSS）的临床表现、检查特征及临床电生理特征，探讨与原发性干燥综合征外周神经系统病变相关的潜在危险因素。
在南方医院进行了一项回顾性病例对照研究，纳入108例根据2016年美国风湿病学会修订标准诊断为pSS的患者。研究时间跨度为2015年1月至2020年10月。将患者队列分为两组，实验组（N = 27）为原发性干燥综合征-外周神经系统病变（pSS-PNS）患者，对照组（N = 81）为无外周神经损伤的患者，即原发性干燥综合征-非外周神经系统病变（pSS-nPNS）患者。
结果显示免疫球蛋白G（IgG）、α - 血影蛋白免疫球蛋白G（α - FIgG）、血小板计数（PLT）、口干与干燥综合征外周神经病变之间存在显著相关性（p < 0.01）。研究还表明，α - FIgG（比值比2.03；95%置信区间1.14 - 3.64）、IgG（比值比1.23；95%置信区间1.06 - 1.42）和PLT（比值比1.01；95%置信区间1.00 - 1.01）被确定为干燥综合征外周神经病变发病的危险因素，而口干呈负相关（比值比0.08；95%置信区间0.02 - 0.40）。值得注意的是，自变量的总风险评估显示曲线下面积（AUC，95%置信区间）高达0.923（0.861 - 0.986；p < 0.001），表明通过ROC分析对pSS-PNS的发生具有良好的预测能力。此外，发现血小板计数高和抗SSB抗体滴度强阳性是pSS-PNS患者运动和感觉神经双重损伤的危险因素。
IgG、α - FIgG和PLT被确定为pSS-PNS患者的独立危险因素。外周神经病变的可能性似乎随着上述三个因素水平的升高而增加。有趣的是，我们发现在这种情况下口干可能起到保护作用。我们的研究还指出，血小板计数高和抗SSB抗体滴度强阳性都可能与pSS-PNS患者运动和感觉神经受累风险增加有关。这些发现对pSS-PNS的病因学和治疗都具有重要意义。
