Pulmonary manifestation in children with systemic lupus erythematosus / 中华实用儿科临床杂志

ABSTRACT

Objective To observe the incidence,clinical types,and prognosis of pulmonary involvement in children with systemic lupus erythematosus(SLE),and to probe the relationship between the relative factors.Methods The clinical data of 61 children with SLE,who treated in Children's Hospital of Shanghai from Jan.2006 to Dec.2011 were analyzed retrospectively.The lung manifestations of the patients were classified according to their clinical symptoms and signs,and lung imaging examination (chest X-ray and CT).Other data of the SLE patients with lung injury or without lung injury were collected,including the course of the disease,activity index [SLE disease activity index (SLEDAI) scoring 0-4 was divided into no activity,5-9 was divided into low activity,10-14 was divided into moderate activity,and more than 15 as severe activity],blood sedimentation,the values of serum complement and the positive rate of dsDNA in autoantibody,and a comparison was made and statistical analysis was performed.Results Pulmonary injury occurred in 17 cases with an incidence rate of 27.9％ (17/61 cases),and the average course of the disease was (8.76 ± 6.96) months.The clinical manifestations of 17 cases included fever,cough,dyspnea,hypoxemia,chest pain,lower breath sound,and lung rale,which were not non-specificity.According to imageological examination,in 17 cases there were 2 cases with pulmonary hypertension (the incidence rate was 11.8％),4 cases with acute lupus pneumonitis (the incidence rate was 23.5％),6 cases with interstitial pneumonia (the incidence rate was 35.3％),7 cases with lesion of pleura (the incidence rate was 41.2％),10 cases with pulmonary infection (the incidence rate was 58.8％).There were no statistical differences between patients with and without lung injury(infectious and non-infectious)in the course,the values of serumn complement,the positive rate of dsDNA and activity index.Lung lesions of the 17 patients recovered quickly after early diagnosis and active treatment.Conclusions Pulmonary manifestation in children with SLE is not uncommon,and it can happen at any stage of the disease,not just on the stage of lupus activity,but it usually indicates disease was not controlled.Pulmonary manifestation of SLE in children involve many parts of lung,including pulmonary parenchyma,interstitial,blood vessels,pleura,etc.Early diagnosis and active treatment can improve the short-term prognosis of lung injury with lupus,and long-term outcome remains to be observed.