系统性红斑狼疮合并中枢神经系统感染30例临床分析

Clinical analysis of 30 patients with systemic lupus erythematosus complicated with central nervous system infections

目的探讨系统性红斑狼疮（SLE）合并中枢神经系统感染病例的临床表现、治疗及预后特点。方法回顾性分析30例诊断明确，资料完整的SLE合并中枢神经系统感染患者。结果1986年1月至2007年3月共收治SLE患者3039例，其中合并中枢神经系统感染者30例占1％，平均年龄（34±11）岁，其中女性27例，男性3例。30例患者中结核性感染11例占37％，非结核的细菌感染11例占37％，真菌感染8例占26％。中枢神经系统感染的患者以发热、头痛、意识障碍为常见临床表现。预后方面3组间差异无统计学意义。结论SLE患者合并中枢神经系统感染表现不典型，最常见的是结核性脑膜炎，及早行腰椎穿刺检查有助于早诊断。低白蛋白血症、低c3及低颅压提示预后不佳。

Objective To investigate the characteristics of clinical manifestations, treatment and prognosis of patients with systemic lupus erythematosus （SLE） complicated with central nervous system （CNS） infection. Methods The medical records of 30 patients with SLE complicated with CNS infection were retrospectively reviewed. Results In the cohort of 3039 SLE patients admitted during last 20-years, 30 patients （1%） were identified with CNS infection. The mean age of patients with CNS infeetion was （34＋11 ） years. Twenty-seven （90%） out of the 30 patients were female. Patients could be divided into 3 groups based on the offending mieroorganisms： mycobacterium tubmrculosis （TB）, non-TB bacterial and fungal infeetion groups respectively. TB infection was identified in 11 patients （37%）, non-TB baeterial infections eould be confirmed in 11 （37%）, and fungal infection in 8 （26%）. The most common presentations of CNS infection were fever, headache, and conscious level changes. There was no difference among the three groups in morta-lity rate. Conclusion The clinical presentations of SEE patients complicated with CNS are generally atypical. Tuberculosis meningitis is the most prevalent CNS infection in patients with SLE. CSF analysis should be done as sotm as possible for establishing early diagnosis. A low serum albumin level, low C3 level and a low intracranial pressure prediets for unfavorable outeomes.