Clinical And Disease Activity Analysis Of 111 Cases Systemic Lupus Erythematosus In Children

Objective:To explore the clinical characteristics,therapy as well as disease activity of pediatric systemic lupus erythematosus so as to provide basis for daily clinical work.Method: The clinical data which include the clinical symptoms, laboratory examination, disease activity and therapy concerning 111 cases of systemic lupus erythematosus in chilren who was in hospital during the period between January, 1999 to Feberary, 2010 were reviewed and analyzed, combined with close follow-up with the disease activity index of some cases for better understanding of therapy efficiency. All patients fullfilled four or more criteria defined by American College of Rheumatology in 1997.Result: The systemic lupus erythematosus(SLE) in children is prevelent mostly amongst adolescent with no gender distinction(t=0.097,P=0.923).The ratio between boys and girls is 1:5.93 .The mean age of onset of the disease in girls is 11.71±2.41y,whereas in boys is 11.64±2.94y. The clinical symptoms commonly occur in forms of rash(66%), fever (59%)and arthritis(32%). Renal(59%) and blood system(52%) are more susceptible than other organs, while the neuropsychiatric involvement in pediatric SLE will get a higher SLEDAI score. The laboratory findings show that immunoglobin level is raised and IgG level raised in an obvious way(59%) with no gender distiction(χ2=0.001,P=0.981). The positive rate of auto-antibody such as ANA(69%),ds-DNA(63%),ss-DNA(75%)and Sm(52%) is highened.Moreover, the blood routine test indicates obvious decreased erythrocyte(73%), thrombocyte(37%) and leucocyte(19%). The urine test shows albuminuria(46%) mostly, but hematuria was rare with naked eyes. The above clinical symptoms occur to both genders without distinctions. WHOⅣwas the most common type in renal biopsy. Pathological changes are identified as diffuse hyperplasia and Mesangial proliferative, as well as tubulointerstitium pathological. Glucocorticoid therapy is given priority to children with SLE. Methyl-prednisone or/and cyclophosphamide and other immunosuppressive shall be applicable based on its severity. However, the period of treatment would last long. According to SLEDAI(Systemic lupus erythematosus disease activity index), morbidity of pediatric SLE is mostly in medium or high degree level, starting in diverse forms. Through SLEDAI evaluation upon followed cases, we found that the average scores declined slightly, indicating the efficiency of this therapy. SLEDAI can be used to judge the severity of SLE, but which is not usually consistent with the SLEDAI score level. Therefore, it still has heavy difficulty in applying in routine clinical work.Conclusion : The clinical symptoms of systemic lupus erythematosus in children are complicated.It is necessary to improve relevant examinations for duly diagnosis and the following treatment. The accuracy and practicability of SLEDAI still remains to be testified.