神经精神狼疮患者影像学表现与自身抗体水平和预后的关系

目的：探讨神经精神狼疮（NPSLE）患者头部磁共振成像（MRI）表现与自身抗体水平的关联性，阐明MRI表现对判断NPSLE预后的意义。 方法：收集36例诊断明确、资料完整的NPSLE患者的临床资料，将患者分为存活组（n=27）和死亡组（n=9）。采用间接免疫荧光法检测抗核抗体；胶体金斑点渗透法检测抗dsDNA抗体；免疫印迹法检测抗Sm、抗SSA、抗SSB、抗U1-RNP和抗核糖体P蛋白抗体；ELISA法检测抗心磷脂抗体（ACL）。分析MRI表现及其与自身抗体和预后的关联性。 结果：32例NPSLE患者头部MRI表现异常，阳性率为88.9%。头部MRI示弥漫性病变21例，局灶性病变10例，单纯性脑萎缩1例。弥漫性病变表现为多发点状或片状病灶，T1WI呈等或低信号、T2WI呈高信号、FLAIR呈高信号；局灶性病变为单一部位的点状或片状病灶，T1WI呈等信号、T2WI呈高信号。病灶部位包括基底节区、皮层下白质、侧脑室前后角和半卵圆中心、大脑皮质、脑干及小脑灰白质。死亡组9例患者中6例表现为局灶性病变，其局灶性病变患者比例明显高于存活组（P<0.01）；死亡组脑干和基底节区病变数比例分别为11.5%和26.9%，均明显高于存活组（P<0.05或P<0.01）；局灶性病变者ACL阳性率显著高于弥漫性病变者（P<0.05）。结论：MRI呈局灶性病变、病变累及脑干和基底节区的NPSLE患者预后较差；且ACL与局灶性病变有关。NPSLE患者MRI表现与自身体具有一定关联性，MRI表现可在一定程度上判断NPSLE患者的预后。

Correlation between imaging findings and autoantibody levels and prognosis in patients with neuropsychiatric systemic lupus erythematosus

Objective To investigate the correlation between cranial magnetic resonance imaging(MRI) findings and autoantibody levels in patients with neuropsychiatric systemic lupus erythematosus(NPSLE),and to elucidate the role of MRI findings in predicting the prognosis of NPSLE.Methods In total,36 well-documented cases of NPSLE diagnosed definitely were selected.All the patients were divided into survival group(n=27) and dead group(n=9).Anti-nuclear antibodies and anti-dsDNA antibodies in serum were detected by indirect immunofluorescence and colloidal gold spot penetration method,respectively.Immunoblotting method was used to detect anti-Sm,anti-SSA,anti-SSB,anti U1-RNP,and anti-ribosomal P protein antibodies.Anti-cardiolipin antibody(ACL) was detected by ELISA method.The correlation between MRI findings of cerebral lesions and autoantibodies,and prognosis was analyzed.Results Cranial MRI scans on admission were abnormal in 32 patients(88.9%),among which 21 cases showed diffuse manifestations,10 cases showed focal lesion in brain and 1 case showed brain atrophy.The diffuse lesion on MRI showed multiple spotty or patchy normal intensity signal on T1-weighted image(T1WI) and high-intensity signal changes on T2-weighted image(T2WI).The focal lesion showed single spotty or patchy normal intensity signal on T1WI and high-intensity signal changes on T2WI.The lesion sites included basal ganglia,subcortical white matter,anterior and posterior horn of lateral ventricle,semiovale center,cerebral cortex,brainstem and cerebellum.Of 9 patients in dead group,6 cases presented with focal lesion and the percentage of focal lesion cases in dead group was significantly higher than that in survival group(P<0.01).The percentages of lesion number in brainstem and basal ganglia in dead group were 11.5% and 26.9%,respectively,which were significantly higher than those in survival group(P<0.05 or P<0.01).The positive rate of ACL in cases with focal lesion was higher than that in cases with diffuse lesion(P<0.05).Conclusion NPSLE patients with focal lesion,brainstem and basal ganglia involvement on cranial MR images show an unfavorable outcome.ACL is associated with focal lesion.There is a certain correlation between MRI findings and autoantibodies in patients with NPSLE.MRI findings may help to predict the prognosis of NPSLE to some extent.