Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China.
Clin Rheumatol. 2024 Sep;43(9):2927-2932. doi: 10.1007/s10067-024-07060-w. Epub 2024 Jul 23.
Neonatal systemic lupus erythematosus (NLE) is an acquired autoimmune disease. The presence of effusions, such as pleural effusion and pericardial effusion, is rare. The present study helped investigate the clinical characteristics and progression of children with NLE combined with effusions.
Clinical data of patients diagnosed with NLE were retrospectively collected and analyzed from January 1, 2011, to December 31, 2023, at the Children's Hospital of Soochow University and Suzhou Municipal Hospital. Patients with NLE were divided into effusion and non-effusion groups based on the presence of effusion. Moreover, the clinical data of the newborns in both groups were compared and investigated.
Eleven (11/45, 24.44%) NLE patients had effusions, such as pleural effusion, testicular hydrocele, peritoneal effusion, pericardial effusion, and hydrocephalus. Other organs involved in effusion patients were cutaneous, gastrointestinal, hematologic, cardiac, and neurological. Among the patients with effusion, five cases of SLE in pregnant mothers, two cases of Sjogren's syndrome, one case of photoallergic symptoms, and three of pregnant mothers with no history of antenatal autoimmune disease. Pregnant mother' autoimmune disease in remission prior to pregnancy, or stable low disease activity. Seven patients were positive for Anti-SSA, five of which were double positive for Anti-SSA and Anti-SSB. Compared with the non-effusion group, the effusion group patients had significantly higher lactate dehydrogenase, creatine kinase, and fibrinogen, significantly lower platelets, total protein, and albumin. These patients were likelier to have thrombocytopenia and coagulation abnormalities. Logistics regression analysis demonstrated that NLE patients with effusions are more likely to have decreased serum total protein levels. All NLE patients with effusion have self-resorption of the effusion.
24.44% of patients had effusions in our study. NLE patients with effusion are more likely to have hematologic involvement and a more inflammatory response. The effusion in NLE patients is usually self-resorption, severe cases can be treated with nonsteroidal anti-inflammatory drugs/steroids. Key Points • NLE patients combined with effusions and were self-limiting, with pleural effusion being the most common. • NLE patients combined with effusions have a more inflammatory response, significant abnormalities in the blood routine and biochemical-related indexes.
新生儿系统性红斑狼疮（NLE）是一种获得性自身免疫性疾病。胸腔积液和心包积液等渗出液并不常见。本研究旨在探讨伴有渗出液的 NLE 患儿的临床特征和转归。
回顾性收集 2011 年 1 月 1 日至 2023 年 12 月 31 日苏州大学附属儿童医院和苏州市立医院诊断为 NLE 的患儿临床资料。根据是否存在渗出液将 NLE 患儿分为渗出液组和非渗出液组。比较两组新生儿的临床资料。
11 例（11/45，24.44%）NLE 患儿存在渗出液，包括胸腔积液、睾丸鞘膜积液、腹腔积液、心包积液和脑积水。其他渗出液患儿受累器官为皮肤、胃肠道、血液、心脏和神经。渗出液患儿中，有 5 例母亲为系统性红斑狼疮，2 例干燥综合征，1 例光过敏症状，3 例母亲无产前自身免疫性疾病史。母亲在妊娠前自身免疫性疾病缓解或病情稳定、低疾病活动度。7 例患儿抗 SSA 阳性，5 例抗 SSA 与抗 SSB 双阳性。与非渗出液组相比，渗出液组患儿乳酸脱氢酶、肌酸激酶、纤维蛋白原显著升高，血小板、总蛋白、白蛋白显著降低，更易发生血小板减少和凝血异常。Logistic 回归分析显示，NLE 患儿存在渗出液时更易出现血清总蛋白水平降低。所有伴有渗出液的 NLE 患儿均自行吸收渗出液。
本研究中 24.44%的患儿存在渗出液。伴有渗出液的 NLE 患儿更易发生血液系统受累和炎症反应。NLE 患儿的渗出液通常可自行吸收，严重者可给予非甾体抗炎药/激素治疗。关键点：• NLE 患儿伴发渗出液具有自限性，以胸腔积液最常见。• 伴有渗出液的 NLE 患儿炎症反应更明显，血常规和生化相关指标显著异常。
