磁共振成像在儿童系统性红斑狼疮脑损伤早期发现中的应用价值

The value of brain magnetic resonance imaging in the early diagnosis of neuropsychiatric systemic lupus erythematosus

目的 探讨头颅磁共振成像（MRI）对早期发现儿童系统性红斑狼疮（SLE）脑损伤的作用.方法 分析2007年3月至2015年3月首都儿科研究所附属儿童医院住院的44例初发SLE患儿,未给予激素和免疫抑制剂治疗前头颅MRI、脑电图、脑脊液和头颅CT结果,详细记录症状、体征、临床表现.计数资料采用x2检验或者Fisher精确检验法,计量资料采用t检验.结果 MRI正常17例,异常27例中脑萎缩17例（63％）、脑梗死9例（33％）、脑白质脱髓鞘改变8例（30％）、脑出血3例（11％）、椎动脉狭窄1例（4％）、弥散异常11例（41％）.脑电图正常34例,异常10例患儿均出现广泛慢波,其中5例合并出现尖棘波.脑脊液正常38例,异常6例患儿蛋白均升高,其中5例细胞数升高,1例出现蛋白、细胞数升高,糖和氯化物降低表现.头颅CT检查8例,正常6例,异常2例均表现为脑梗死.中枢神经系统症状正常28例,异常16例患儿中持续头疼15例、持续头晕9例、惊厥7例、肢体偏瘫3例、视物模糊1例.神经系统查体正常34例,异常10例患儿中颅神经受累2例、颈抵抗阳性10例、锥体束征阳性5例、肌力下降3例、感觉异常1例.头颅MRI阳性发现率与脑电图、脑脊液、中枢神经系统症状、神经系统查体的阳性发现率比较差异均有统计学意义,统计值分别为x2=12.055、P=0.001,x2=19.627、P=0.001,x2 =3.859、P=0.049,x2=12.055、P=0.001.结论 与CT、脑电图、脑脊液检查、中枢神经系统症状、神经系统查体相比,头颅MRI检查早期发现儿童SLE损伤阳性率更高.儿童SLE确诊后行头颅MRI可发现早期狼疮脑病.弥散加权成像异常是儿童神经精神性狼疮常见影像学改变,是SLE活动的表现.

Objective To investigate the value of brain magnetic resonance imaging （MRI） in evaluating the intracranial injuries in patients with juvenile onset systemic lupus erythematosus （SLE）.Method Data of brain MRI,CT,electroencephalogram （EEG）,cerebrospinal fluids analysis and clinical features of the central nervous system of 44 patients from March 2007 to March 2015 with juvenile onset SLE who were not treated with glucocorticoids （Gcs） and immunosuppressive agents （Is） were retrospectively analyzed and compared.Result Twenty-seven out of 44 patients demonstrated abnormal signs on brain MRI,including encephalatrophy,cerebral infarction,demyelination,encephalorrhagia,vertebral arteriostenosis and abnormal signals on the brain diffusion-weighted imaging （DWI）.Sixteen patients had clinical features of the central nervous system involvement,fifteen had continuous headache,nine had continuous dizziness,seven had convulsions,three had hemiplegia,one had blurred vision.Physical examination of the nervous system：ten patients had abnormal signs,all had cervical rigidity,five showed pyramidal sign,three showed loss of muscle tone,two with cranial neuropathies and one had paresthesia.EEG：Ten patients showed abnormal waves on EEG,all showed diffused slow-waves,and five showed sharp waves and spikes.Cerebrospinal fluids analysis：six patients had abnormal results,five of them had cell count elevation and one had cell count and protein elevation,while there was glucose and chloride degression.Brain CT：Eight patients received CT scan,two showed cerebral infarction.x2 test was used to compare the differences among head MRI,EEG,cerebrospinal fluid analysis,physical examination of the nervous system,clinical features of the nervous system,the difference was significant（x2 =12.055,P =0.001;x2 =19.627,P=0.001;x2 =3.859,P=0.049;x2 =12.055,P=0.001）.Conclusion Brain MRI may be a better method in early diagnosis of intracranial injuries than CT,EEG,cerebrospinal fluid analysis and physical examination of the nervous system.Patients with juvenile onset SLE should receive brain MRI after diagnosis in order to investigate the intracranial injuries.Abnormal signals on the DWI are the signs of active disease.