Clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus in children at the initial diagnosis / 中华实用儿科临床杂志

ABSTRACT

Objective:To investigate the incidence and clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus (SLE) at the initial diagnosis.Methods:The clinical data of 74 children with SLE admitted to the Department of Rheumatology in Children′s Hospital Affiliated to Xi′an Jiaotong University for the initial diagnosis from January 2012 to May 2019 were subject to retrospective analysis.They were divided into the cranial imaging abnormality group and the cranial imaging non-abnormality group according to the imaging.A description and statistical analysis were carried out for both groups with respect to the course before initial diagnosis, gender, rash, arthralgia, hair loss, pulmonary lesions, white blood cells (WBC), hemoglobin (Hb), platelets (PLT), erythrocyte sedimentation rate (ESR), serum ferritin (FER), serum complement values (C 3 and C 4), anticardiolipin antibody (ACA), alanine aminotransferase (ALT), aspartate transaminase (AST), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC). Results:Seventy-four children with SLE underwent a cranial imaging exa-mination at the initial diagnosis, including 52 cases for magnetic resonance imaging (MRI) and 22 cases for CT.There were 36 abnormal cases (48.6%), including 27 cases (51.9%) in MRI and 9 cases (40.9%) in CT.Among 36 cases of abnormal cranial imaging in children with SLE, MRI abnormalities were mainly demyelinating lesions and sulcus widening (brain atrophy), while CT abnormalities were mainly sulcus widening (brain atrophy). There were 21 cases presenting with neurological symptoms, including 17 cases of headache, 11 cases of dizziness, 3 cases of convulsions, and 1 case of coma.There were no significant differences between both groups in the course before initial diagnosis, gender, rash, arthralgia and hair loss.Among the 36 cases of SLE with cranial imaging abnormalities, 20 cases presented with interstitial pulmonary lesions, of which 4 cases presented with pulmonary hemorrhage; Among 38 cases of SLE without cranial imaging abnormality, 8 cases presented with interstitial pulmonary lesions, which indicated that there were statistical differences between both groups; within terms of the laboratory test items, there were significant differences in PLT between both groups, and there was no significant difference in WBC, Hb, ESR, FER, C 3, C 4, ACA, ALT, AST, TG, HDL, LDL and TC. Conclusions:The cranial imaging abnormalities in children with SLE, especially the earlier occurrence in MRI, may occur before the manifestation of clinical symptoms of the nervous system.They were also associated with other important organ damages, such as abnormal blood system and lung lesions.Early detection may contribute to the short-term prognosis.