系统性红斑狼疮合并产单核李斯特菌脑膜炎临床分析

Listeria monocytogenes meningitis in systemic lupus erythematosus patients

目的总结SLE合并产单核李斯特菌脑膜炎的临床特点。方法回顾性分析北京协和医院15年来SLE患者继发产单核李斯特菌脑膜炎患者的临床表现、系统受累、实验室检查、脑脊液特点、治疗和预后。结果SLE继发产单核李斯特菌脑膜炎患者8例，占同期SLE住院患者（5 675例）的0.14%。①女性7例，男性1例，平均（35±16）岁；②神经系统表现以头痛（7/8）、脑膜刺激征阳性（5/8）、意识障碍（3/8）、恶心呕吐（2/8）常见；③脑脊液压力升高7例（7/8），4例〉330 mmH2O（4/8），脑脊液蛋白升高6例（6/8），葡萄糖下降6例（6/8）；④多发于SLE稳定或轻度活动期，系统表现包括血液系统（6/8）、皮肤（4/8）、肾脏（4/8）、关节炎（3/8）等。发病时平均SLEDAI为4.7±1.5；⑤经青霉素为主的抗感染及原发病治疗，7例患者好转，1例死亡。结论产单核李斯特脑膜炎是SLE少见的机会性感染，多发于SLE稳定期，临床表现、实验室及脑脊液检查特异性差，需多次培养得到阳性结果确诊，早期识别及治疗可改善预后。

Objective To summarize the clinical characteristics of SLE patients complicated with Listeria monocytogenes meningitis （LMM）. Methods The clinical manifestations, systemic involvements, laboratory tests, cerebrospinal fluid （CSF） examinations, treatment and prognosis of SLE inpatients combined with LMM in Peking Union Medical College Hospital during Janurary 2000 to December 2015 were retros- pectively analyzed. Results Eight SLE patients with LMM accounted for 0.14% of the 5 675 hospitalized SLE patients. Seven were female and 1 was male, with the mean age of （35±16） year. Headache （7/8） was the most common neurological symptom followed by positive meningeal irritation sign （5/8）, unconsciousness （3/8） and nausea or vomiting （2]8）. Increased intracranial pressure was found in 7 cases and 4 of them were even higher than 330 mmH20. CSF protein elevated in 6 cases and CSF glucose decreased in 6 cases. LMM often occurred in inactive or mild active SLE with the average SLE disease activity index （SLEDAI） score of 4.7±1.5. Systemic manifestations included hematologici changes （618）, rashes （4/8）, renal involvement （4/8） and arthritis （3/8）, etc. Treated by antibiotics such as penicillin and medications for SLE, 7 patients achieved clinical improvements, 1 patient died. Conclusion LMM is one of the opportunistic infections in SLE patients and tends to occur in inactive lupus cases. There are unspecific clinical and laboratory features and CSF changes whieh maybe overlap and mix up with systemic manifestations of SLE. That＇s why it is necessary to take continuous cultures of CSF. Early identification and appropriate treatment lead to prognostic improvement of these patients.