青少年起病的神经精神性系统性红斑狼疮住院患者疾病活动度、神经精神症状、影像学特征及癫痫发作危险因素的综合分析

Comprehensive analysis of disease activity, neuropsychiatric symptoms, imaging features and risk factors for seizure in hospitalized patients with juvenile-onset neuropsychiatric systemic lupus erythematosus.

作者信息

Tang Yufen, Huang Peng, Xu Jie, Liu Lingjuan, Wu Xiaochuan, Cao Yan, Dang Xiqiang, Zhang Lu, She Zhou, Luo Senlin, Peng Hong, Chen Yuqiong, Luo Jinwen, Duan Wangxin, He Xiaojie, Yuan Fang, Mao Dingan, Liu Liqun

机构信息

Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha 410011 Hunan, China; Department of Pediatric Neurology, Children's Medical Center, The Second Xiangya Hospital of Central South University, Changsha 410011 Hunan, China; Hunan Provincial Children's Developmental and Behavioral Clinical Medical Research Center, Changsha 410011 Hunan, China.

Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha 410011 Hunan, China; Department of Pediatric Nephrology, patientren's Medical Center, The Second Xiangya Hospital of Central South University, Changsha, China.

出版信息

Semin Arthritis Rheum. 2025 Oct;74:152798. doi: 10.1016/j.semarthrit.2025.152798. Epub 2025 Aug 5.

DOI:10.1016/j.semarthrit.2025.152798

PMID:40784140

Abstract

BACKGROUND

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a common complication of juvenile systemic lupus erythematosus, with high morbidity and lethality rates. This study aimed to comprehensively analyze the clinical characteristics and related influencing factors of NPSLE, providing important basis for the early detection and early diagnosis of NPSLE.

METHODS

The clinical data of juvenile-onset NPSLE patients, juvenile non-NPSLE patients, and adult-onset NPSLE patients admitted to the Xiangya Second Hospital of Central South University from January 2010 to December 2023 were retrospectively analyzed. The data of the juvenile-onset NPSLE patients were divided into subgroups via a cluster analysis. Drawing upon retrospective clinical data and case reports from databases, a thorough synthesis of the characteristics of Juvenile-onset NPSLE cases presenting with seizures was presented. Multivariate logistic regression analysis was utilized to assess influencing factors of juvenile-onset NPSLE with seizures.

RESULTS

A total of 89 juvenile-onset NPSLE patients, 219 juvenile-onset non-NPSLE patients, and 150 adult-onset NPSLE patients were included. Compared to non-NPSLE patients, juvenile-onset NPSLE patients showed higher rates of myositis, cardiac involvement, overlap syndrome, anti-SSA antibodies and ANCA positivity, as well as higher disease activity scores. Individuals with juvenile-onset NPSLE exhibited a greater likelihood of headaches, seizures, and movement disorders and renal involvement, positive rates of anti-dsDNA and anti-nucleosome antibodies, and disease activity scores, while displaying a lower probability of polyneuropathy in comparison to adult patients. Disease activity emerged as an independent risk factor for seizures.

CONCLUSION

These findings contribute to the early detection of potential NPSLE patients and help clinicians to pay attention to potentially high-risk populations for NPSLE.

摘要

背景

神经精神性系统性红斑狼疮（NPSLE）是青少年系统性红斑狼疮常见的并发症，发病率和致死率较高。本研究旨在全面分析NPSLE的临床特征及相关影响因素，为NPSLE的早期发现和早期诊断提供重要依据。

方法

回顾性分析2010年1月至2023年12月在中南大学湘雅二医院住院治疗的青少年起病的NPSLE患者、青少年非NPSLE患者及成人起病的NPSLE患者的临床资料。采用聚类分析将青少年起病的NPSLE患者数据分为亚组。基于回顾性临床资料和数据库中的病例报告，全面综合呈现青少年起病的NPSLE伴癫痫发作病例的特征。采用多因素logistic回归分析评估青少年起病的NPSLE伴癫痫发作的影响因素。

结果

共纳入89例青少年起病的NPSLE患者、219例青少年非NPSLE患者和150例成人起病的NPSLE患者。与非NPSLE患者相比，青少年起病的NPSLE患者肌炎、心脏受累、重叠综合征、抗SSA抗体及ANCA阳性率更高，疾病活动度评分更高。青少年起病的NPSLE患者头痛、癫痫发作、运动障碍和肾脏受累、抗双链DNA及抗核小体抗体阳性率和疾病活动度评分的发生可能性更大，而与成人患者相比，多发性神经病的发生概率更低。疾病活动度是癫痫发作的独立危险因素。