狼疮患者中枢神经系统感染与狼疮脑病的鉴别

目的分析系统性红斑狼疮（SLE）合并中枢神经系统（CNS）感染患者的临床特点，探讨其和狼疮脑病的鉴别诊断。方法选择我科住院并确诊为SLE合并CNS感染的20例患者为感染组，另设同期确诊为狼疮脑病的36例患者为对照组，记录并分析2组的临床表现、脑脊液（CsF）、头颅磁共振（MRI）、免疫学、血生化指标。结果感染组较对照组病程短，发病时激素用量大，狼疮疾病活动指数（SLEDAI）评分明显低于对照组；临床表现以发热、头痛为主，而对照组以精神行为异常为主；血抗双链DNA抗体、CSF压力、蛋白质和细胞数与对照组比较均有明显差异；且预后较对照组差。结论无病原学依据的CNS感染可从临床表现、狼疮疾病活动指数、CSF改变等方面与狼疮脑病鉴别。

Differential diagnosis of systemic lupus erythematosus complicated with centric nervous system infection and lupus encephalopathy

Objective To analyze the clinical features of systemic lupus erythematosus （SLE） complicated with centric nervous system （CNS） infection, and discusse the differential diagnosis between it and lupus encepalophathy. Methods Twenty inpatients with SLE complicated with CNS infection were chosen and served as infection group, and 36 patients with lupus eneephalopathy at the same period served as control group. The clinical manifestations, cerebrospinal fluid （CSF）, head MRI images, immunologie and blood biochemical indexes in the two groups were analyzed. Results In infection group, the course of disease in infection group was shorter, the dosage of prednisone was higher, and lupus disease activity index was significantly lower than in control group. The main clinical manifestations in infection group were fever, headache, and those in control group included abnormal psychiatric behavior. There was significant difference in blood anti-ds-DNA antibody, CSF pressure and eell count between infection group and control group. The prognosis in infection group was worse than in control group. Conclusions CNS infection without etiology eould be distinguished with lupus eneephalopathy through clinical manifestations, disease activity index, and changes in CSF.