本文關(guān)鍵詞： 神經(jīng)精神狼瘡 臨床表現(xiàn) 免疫學(xué) 危險(xiǎn)因素 腦電圖　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的探討神經(jīng)精神性狼瘡患者臨床表現(xiàn)、實(shí)驗(yàn)室及免疫學(xué)檢查特點(diǎn)。方法回顧分析2011年2月-2014年2月在寧夏醫(yī)科大學(xué)總醫(yī)院住院并確診為神經(jīng)精神狼瘡患者124例(為NPSLE組),同期住院診斷為系統(tǒng)性紅斑狼瘡且不伴有神經(jīng)精神癥狀患者94例(SLE組),分析2組患者實(shí)驗(yàn)室檢查結(jié)果的差異性。結(jié)果1.SLE患者神經(jīng)精神癥狀多出現(xiàn)在病程早期,最常見(jiàn)的臨床癥狀為關(guān)節(jié)炎和皮疹;2.NPSLE組患者的病程明顯小于SLE組患者(Z=-2.516,P=0.012),而性別及系統(tǒng)累及情況無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);3.NPSLE組患者比SLE組患者更易出現(xiàn)皮疹、口腔潰瘍和光過(guò)敏(χ2=9.266,P=0.002;χ2=5.298,P=0.030;χ2=7.694,P=0.004);4.NPSLE組患者中大部分同時(shí)或相繼出現(xiàn)2種或2種以上神經(jīng)精神癥狀,最常見(jiàn)的癥狀為頭痛;5.NPSLE組患者血清中的血小板比SLE組患者低(t=-5.416,P=0.000),而谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、肌酸激酶較SLE組患者相比明顯升高(Z=-3.283,P=0.001;Z=-4.561,P=0.000;Z=-4.300,P=0.000),但血白細(xì)胞、紅細(xì)胞、血紅蛋白、肌酐、白蛋白、血脂等實(shí)驗(yàn)室指標(biāo)無(wú)明顯差異性(P0.05);6.NPSLE組患者血清中免疫球蛋白M較SLE組患者相比明顯升高(Z=-2.471,P=0.013),補(bǔ)體C4較SLE組患者明顯降低(Z=-3.006,P=0.003),兩組患者抗-Rib抗體陽(yáng)性率有明顯統(tǒng)計(jì)學(xué)意義(χ2=4.947,P=0.026),而血沉、CRP、抗-ds DNA抗體、抗磷脂抗體、補(bǔ)體C3,免疫球蛋白G、A、Hep2-ANA等免疫學(xué)指標(biāo)無(wú)明顯差異性(P0.05);7.Spearman相關(guān)分析可見(jiàn):抗ds-DNA抗體與病程、補(bǔ)體C4呈負(fù)相關(guān),相關(guān)系數(shù)分別為(r=-0.331,P=0.000)、(r=-0.332,P=0.000),腦電圖的異常程度與補(bǔ)體C4呈負(fù)相關(guān)(r=-0.252,P=0.012),補(bǔ)體C4水平與病程呈正相關(guān)(r=0.249,P=0.006);8.采用Logistics回歸分析可見(jiàn),抗-Rib抗體、血小板計(jì)數(shù)、皮疹和血清Ig M含量為NPSLE的危險(xiǎn)因素,其中,抗-Rib抗體陽(yáng)性是發(fā)生NPSLE的獨(dú)立危險(xiǎn)因素(OR=4.276,95%CI=1.631,11.207);9.大多數(shù)神經(jīng)精神狼瘡患者腦電圖有改變,主要呈彌漫性損傷,最常發(fā)生的病變區(qū)域?yàn)轭~區(qū),最常發(fā)生改變的腦電波為θ波;10.采用受試工作者曲線分析可見(jiàn),腦電圖的異常程度及出現(xiàn)異常的腦電波數(shù)對(duì)于診斷神經(jīng)精神狼瘡有一定的價(jià)值。其中,出現(xiàn)異常的腦電波個(gè)數(shù)的最佳臨界值為α波出現(xiàn)異常,敏感度為64.8%,特異度為77.6%,出腦電圖異常程度的最佳臨界值為廣泛輕度異常改變,敏感度為52.4%,特異度為86.9%。結(jié)論1.神經(jīng)精神狼瘡患者易出現(xiàn)在病程早期;2.NPSLE患者常合并其他系統(tǒng)損害,最常見(jiàn)的神經(jīng)系統(tǒng)外臨床表現(xiàn)為關(guān)節(jié)炎和皮疹;3.抗Rib抗體陽(yáng)性是發(fā)生NPSLE的危險(xiǎn)因素之一;4.腦電圖異常程度比腦電波異常個(gè)數(shù)對(duì)預(yù)測(cè)神經(jīng)精神狼瘡的發(fā)生更有臨床意義,聯(lián)合監(jiān)測(cè)患者免疫學(xué)指標(biāo)和腦電圖改變或能提高臨床診斷。
[Abstract]:Objective to investigate the clinical manifestations of neuropsychiatric lupus. Methods from February 2011 to February 2014, 124 patients with neuropsychiatric lupus were diagnosed in Ningxia Medical University General Hospital (NPSLE group) and were diagnosed as systemic erythematosus in the same period. There were 94 patients with SLE without neuropsychiatric symptoms. The differences of laboratory findings between the two groups were analyzed. 1. The neuropsychiatric symptoms of SLE patients appeared in the early stage of the disease. The most common clinical symptoms were arthritis and rash. 2. The course of disease in NPSLE group was significantly smaller than that in SLE group. However, there was no significant difference in sex and systemic involvement. 3. The patients in NPSLE group were more likely to develop rash than those in SLE group. Oral ulcers and light hypersensitivity (蠂 ~ 2 ~ 2 ~ (9.266) P ~ + 0.002; 蠂 ~ 2 ~ 2 ~ (5.298) P ~ (0.030); 蠂 ~ (2) 7.694 ~ (0.004) P ~ (0.004)). Most of the patients in NPSLE group have two or more neuropsychiatric symptoms at the same time or one after another. The most common symptom is that the platelets in serum of patients with SLE are lower than those of patients with SLE, and the levels of glutamate-pyruvic aminotransferase, aspartate aminotransferase and aspartate aminotransferase are lower than those in SLE group. Creatine kinase (CK) was significantly higher than that in SLE group (P < 0.05), but the levels of serum leukocytes, erythrocytes, hemoglobin, creatinine, albumin, serum albumin were significantly higher than those in the SLE group, and the levels of creatine kinase were significantly higher than those in the SLE group, and the levels of creatine kinase were significantly higher than those in the SLE group. Serum immunoglobulin M in patients with SLE was significantly higher than that in patients with SLE. Complement C4 was significantly lower than that in patients with SLE. The positive rate of anti-Rib antibody in both groups was significantly higher than that in patients with SLE. The positive rate of serum immunoglobulin M in patients with NPSLE was significantly higher than that in patients with SLE. The positive rate of serum immunoglobulin M in patients with NPSLE was significantly higher than that in patients with SLE. The positive rate of anti-Rib antibody in the two groups was significantly higher than that in the patients with SLE. (蠂 2 / 4.947) and erythrocyte sedimentation rate (ESR), anti-DS DNA antibody, The correlation analysis of anti-phospholipid antibody, complement C _ 3 and immunoglobulin G _ (2) Agna Hep2-ANA showed that the anti-phospholipid antibody was negatively correlated with the course of disease and complement C _ 4, and there was no significant difference in the correlation between anti-phospholipid antibody and complement C _ 4. The correlation coefficient was 0.331P0. 000, the abnormal degree of EEG was negatively correlated with complement C4, and the level of complement C4 was positively correlated with the course of disease. Logistics regression analysis showed that anti-Rib antibody, platelet count, rash and serum IgM were risk factors of NPSLE. The positive anti-Rib antibody was an independent risk factor for NPSLE. The most common change of EEG is 胃 wave 10. The abnormal degree of EEG and the number of abnormal EEG are valuable for the diagnosis of neuropsychiatric lupus. The best critical value for the number of abnormal EEG waves is the abnormal alpha wave, the sensitivity is 64.8, the specificity is 77.6. the best critical value of abnormal EEG is a wide range of mild abnormal changes. The sensitivity is 52.4 and the specificity is 86.9. Conclusion 1. Patients with neuropsychiatric lupus are prone to occur in the early stage of the disease. 2. NPSLE patients are often associated with other system damage. 2. The most common external clinical manifestations of the nervous system are arthritis and rash 3.The positive Rib antibody is one of the risk factors for the occurrence of NPSLE 4.The degree of abnormal EEG is more important than the number of abnormal EEG in predicting the occurrence of neuropsychiatric lupus. Combined monitoring of immunological parameters and EEG may improve clinical diagnosis.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R593.241

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 宋秀麗,陳茂勛,尤慶偉;裝配工人腦電圖改變的分析[J];河南醫(yī)藥信息;2002年17期

2 宋麗,孫玉香;抽動(dòng)-穢語(yǔ)綜合征93例臨床與腦電圖改變[J];中國(guó)臨床醫(yī)生;2003年03期

3 胡瑞瑯;神經(jīng)官能癥之腦電圖改變[J];實(shí)用內(nèi)科雜志;1986年08期

4 李曉燕;兒童腹痛性癲癇的腦電圖改變[J];九江醫(yī)學(xué);1995年01期

5 劉金霞,盧勇;驚嚇誘發(fā)癲癇與腦電圖改變[J];實(shí)用醫(yī)技雜志;1997年09期

6 郝景梅,楊維蘭,楊玉森;癌癥病人心理及腦電圖改變的臨床治療觀察(附82例報(bào)告)[J];中國(guó)腫瘤臨床與康復(fù);1997年01期

7 傅美華,郭斌;單純皰疹病毒性腦炎的腦電圖和臨床改變[J];山東醫(yī)藥;2001年24期

8 韓友萍,房亞蘭;暈厥性癲癇26例臨床與腦電圖[J];實(shí)用醫(yī)技;2001年01期

9 張穎,魏麗紅;兒童注意缺陷多動(dòng)障礙腦電圖特點(diǎn)與臨床分析[J];實(shí)用兒科臨床雜志;2004年01期

10 許燮萍,周敏杰,盧娜,張志芳;癲癇停藥后復(fù)發(fā)與腦電圖[J];醫(yī)學(xué)信息;2004年12期

相關(guān)會(huì)議論文 前10條

1 吳三樂(lè);;煽油、染發(fā)引起頭痛、頭暈及腦電圖改變[A];2006年浙江省神經(jīng)病學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2006年

2 黃遠(yuǎn)桂;張燕;黃旌;徐格林;陳云春;杜芳;李銳;林華;;發(fā)作性運(yùn)動(dòng)誘發(fā)性運(yùn)動(dòng)障礙的腦電圖改變[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2004年

3 梅珍;安榕榕;劉海云;林巧;鐘忠輝;;兒童良性枕葉癲癇47例臨床及腦電圖特征分析[A];2011中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2011年

4 陳新;;注意缺陷多動(dòng)障礙患兒分型與腦電圖關(guān)系研究[A];中華醫(yī)學(xué)會(huì)第十七次全國(guó)兒科學(xué)術(shù)大會(huì)論文匯編（下冊(cè)）[C];2012年

5 張薇娜;;高血壓性腦出血的腦電圖改變[A];2007年浙江省神經(jīng)病學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

6 劉興洲;;立體定向與硬膜下電極腦電圖[A];第三屆CAAE中國(guó)腦電圖和神經(jīng)電生理大會(huì)論文摘要集[C];2012年

7 徐冬梅;;頭皮腦電圖導(dǎo)聯(lián)組合設(shè)置與定位技術(shù)[A];第三屆CAAE中國(guó)腦電圖和神經(jīng)電生理大會(huì)論文摘要集[C];2012年

8 王貴菊;;兒童注意缺陷多動(dòng)障礙腦電圖特點(diǎn)與臨床分析[A];山東省第六屆一次兒科護(hù)理學(xué)術(shù)交流會(huì)議論文匯編[C];2006年

9 王侃;葉飛;戴玉璇;徐婷;趙嬋;;窒息新生兒腦血流及腦電圖的改變和臨床意義[A];2011年浙江省醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)學(xué)術(shù)年會(huì)暨兒內(nèi)科疾病診治新進(jìn)展國(guó)家級(jí)學(xué)習(xí)班論文匯編[C];2011年

10 林鴻彬;;癲癇患者的腦電圖,腦血流圖的研究[A];第九次全國(guó)神經(jīng)病學(xué)學(xué)術(shù)大會(huì)論文匯編[C];2006年

相關(guān)重要報(bào)紙文章 前2條

1 ;眩暈一定要查腦電圖嗎[N];保健時(shí)報(bào);2004年

2 江西醫(yī)學(xué)院門(mén)診部 白淑卿;腦電圖原理與臨床檢測(cè)[N];家庭醫(yī)生報(bào);2004年

相關(guān)碩士學(xué)位論文 前5條

1 張芮君;神經(jīng)精神狼瘡患者臨床表現(xiàn)及免疫學(xué)特點(diǎn)分析[D];寧夏醫(yī)科大學(xué);2015年

2 劉勇;定量腦電圖對(duì)于急性幕上腦梗死早期診斷及預(yù)后判斷的價(jià)值[D];蘇州大學(xué);2006年

3 張曉東;輕度認(rèn)知功能障礙者及老年癡呆患者腦電圖預(yù)警指標(biāo)探索性研究[D];山西醫(yī)科大學(xué);2010年

4 王佳;輕度認(rèn)知功能障礙患者在工作記憶時(shí)的腦電圖功率值及相干性研究[D];浙江大學(xué);2005年

5 劉洋;兒童癲癇的影像學(xué)檢查、腦電圖改變及治療效果的相關(guān)性研究[D];重慶醫(yī)科大學(xué);2014年

，

本文編號(hào)：1508927