系统性红斑狼疮伴中枢神经系统损害的临床分析

目的:探讨系统性红斑狼疮(SLE)伴神经系统病变的临床特征。方法:回顾性分析41例伴中枢神经系统损害的SLE患者(女38例,男3例)的临床特点、辅助检查结果以及治疗效果。结果:SLE中枢神经系统损害以弥漫性症状(51.2%)为多见,其次为局灶性(22.0%)、抽搐发作(12.2%)和其他(14.6%);29例患者中枢神经系统症状发生在SLE病后3年内,占71.7%;32例脑电图(EEG)检查的患者中27例有异常(84.3%),其中21例弥漫性症状患者中EEG异常20例(95.2%);22例局灶性症状患者中13例(59.1%)磁共振成像(MRI)检查异常。21例伴蛋白尿患者同时接受糖皮质激素和环磷酰胺治疗,余20例患者接受单纯糖皮质激素治疗,前者疗效可能优于后者(χ2=5.91,P=0.05)。结论:SLE神经系统损害以颅内弥漫性损害常见,EEG检查有助于早期弥漫性症状患者的诊断,糖皮质激素联合环磷酰胺治疗伴有中枢神经系统损害的SLE,其疗效可能优于单一糖皮质激素治疗。

Clinical analysis of patients with systemic lupus erythematosus associated with central nervous system impairment

Objective To investigate the clinical characteristics of central nervous system (CNS) impairment in patients with systemic lupus erythematosus (SLE). Methods The clinical characteristics of 41 SLE patients with central nervous system impairment (38 female, 3 male) were analyzed retrospectively. Results Diffuse clinical symptom presentation was the most common manifestation (51.2%) in SLE patients with central nervous system impairment, followed by focal clinical symptom presentation (22.0%), seizure presentation (12.2%), and other clinical symptom presentation (14.6%). Central nervous system impairment occurred in 29 (71.7%) patients within 3 years after onset of SLE. Twenty-seven (84.3%) of the 32 cases performed electroencephalography had abnormal electroencephalogram (EEG). Twenty (95.2%) of 21 patients with diffused clinical symptom presentation showed abnormal EEG, and 13 (59.1%) of 22 patients with focal clinical symptom presentation showed abnormal MRI imaging. Twenty-one patients accompanying albuminuria were treated with immune inhibitor (cyclophosphamide, CTX) combined with cortical steroid, the rest of 20 patients were treated with cortical steroid only. The curative effects in the former therapy might be better than that in the later(X<'2>=5.91, P=0.05). Conclusions Diffuse clinical symptom presentation is a common manifestation in SLE patients associated with central nervous system impairment. EEG examination is helpful for the early diagnosis in the patients. In SLE patients associated with central nervous system impairment, cortical steroid combined with cyclophosphoamide is more efficacious than cortical steroid alone.