目的：总结系统性红斑狼疮（SLE）视网膜病变的临床特点，提高临床医生对该病的认识。方法选择2006年5月—2013年8月金华市中心医院及金华眼科医院收治的21例 SLE 视网膜病变患者，回顾性分析其临床资料。结果本组21例患者中，男2例，女19例；年龄为16~51岁，平均（29,1±10,9）岁。SLE 病程为0,3~180,0个月，平均（40,9±43,4）个月。单眼病变14例，双眼病变7例，共累及28只眼，其中视力<0,1共7只眼，视力0,1~0,5共11只眼，视力>0,5共10只眼。眼部病变：视网膜棉绒斑19只眼，视网膜出血13只眼，视网膜中央静脉阻塞（CRVO）6只眼，视网膜脱离4只眼，视网膜分支静脉阻塞（BRVO）3只眼，视网膜新生血管形成2只眼，视神经萎缩2只眼。其他临床表现：蝶形红斑10例，反复发热8例，雷诺现象6例，口腔溃疡5例，多浆膜炎3例。受累脏器：血液系统损害16例，肾损害15例，多关节炎14例，皮肤血管炎8例，神经系统损害7例。实验室检查：抗核抗体（ANA）均为阳性，补体 C3下降、抗双链 DNA 抗体（抗 ds - DNA 抗体）阳性15例，红细胞沉降率加快13例，抗 SSA 阳性8例，抗心磷脂抗体（ACL）阳性、抗核糖核蛋白（RNP）阳性7例，抗 Sm 抗体阳性6例，抗 rRNP阳性5例。SLE 疾病活动度评分（SLEDAI）为2~28分，平均（16,5±6,5）分；SLE 重度活动17例，中度活动2例，轻度活动、病情稳定不活动各1例。除1例 SLE 病情稳定不活动患者外，其余患者均给予糖皮质激素及免疫抑制剂治疗，视网膜散在出血者予以局部治疗；治疗后，15例患者眼部症状有不同程度改善，5只眼（包括 CRVO 4只眼）眼部症状无改善，1例 CRVO 伴狼疮性脑病、狼疮性肾炎患者因继发肺部感染而死亡。结论 SLE 视网膜病变可严重影响患者视力，且易出现多器官受累，病情较重，活动期 SLE 患者应行常规眼底检查；糖皮质激素及免疫抑制剂治疗有效，但 CRVO 患者预后较差。%Objective To analyze the clinical features of retinopathy in patients with systemic lupus erythematosus (SLE),raise doctors' awareness of SLE, Methods Medical records at a total of 21 SLE patients with retinopathy admitted to Jinhua Central Hospital and Jinhua Eye Hospital from May 2006 to August 2013,were selected as study subjects,the medical re-cords were analyzed retrospectively, Results Among the 21 patients,2 were male,19 were female,with an average age of (29, 1 ± 10, 9)years(range:16 - 51 years), The mean duration of SLE was(40, 9 ± 43, 4) months(range:0, 3 - 180, 0 months), Monocular retinopathy was found in 14 patients,bilateral retinopathy in 7 patients,retinopathy was found in 28 eyes, The visual acuity was < 0, 1 in 7 eyes,0, 1 - 0, 5 in 11 eyes, > 0, 5 in 10 eyes, Eye diseases:retinal cotton - wool spot was found in 19 eyes,retinal hemorrhage in 13 eyes,central retinal vein occlusion(CRVO) in 6 eyes,amotio retinae in 4 eyes,and branch retinal vein occlusion(BRVO)in 3 eyes,retinal neovascularization in 2 eyes,optic atrophy in 2 eyes, Other clinical features:butterfly erythema was found in 10 cases,recurrent fever in 8 cases,Raynaud's phenomenon in 6 cases,dent-al ulcer in 5 cases,polyserositis in 3 cases, The affected organs:hematological system damage in 16 patients,renal involvement in 15 patients,arthritis in 14 patients,skin vasculitis in 8 patients,central nerve system involvement in 7 patients, Laboratory tests:positive ANA was found in all cases, decreased complement C3 and positive anti - double - stranded - DNA (anti - dsDNA)antibody in 15 patients,higher ESR in 13 patients,positive anti - SSA in 8 cases,positive anti - cardiolipid antibody(ACL)and anti - RNP in 7 patients,positive anti - Sm antibody in 6 cases,positive anti - rRNP in 5 cases, The mean SLEDAI was(16, 5 ± 6, 5)(range:2 - 28), Severe SLE was found in 17 cases,moderate SLE in 2 cases,mild SLE in 1 case,stable SLE in 1 case, The patients(except for the stable SLE case)were treated with systemic glucocorticoids and immu-nosuppressants,patients with retinal hemorrhage were given topical treatment, After treatment,different degrees of ocular signs improvement was found in 15 cases,improvement of ocular symptoms was not found in 5 eyes(including 4 eyes with CRVO),a patient with CRVO,lupus encephalopathy and lupus nephritis died from lung infection, Conclusion Visual acuity is affected se-riously in SLE patients with retinopathy, Multiple organ involvement and serious condition are common in these patients,SLE pa-tients in active phase should receive routine fundus examination, Glucocorticoids and immunosuppressants are effective,but the prognosis is poor in patients with CRVO.
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