系统性红斑狼疮性脑病临床特征分析

The analysis of clinical features of Neuropsychiatric systemic lupus erythematosus

目的探讨系统性红斑狼疮性脑病的临床特征。方法回顾21例系统性红斑狼疮性脑病患者的临床资料，并进行分析。人组患者均采用激素治疗，维持1a～2a，同时给予抗炎、抑制脑水肿、改善脑血流循环及改善脑细胞代谢药物应用。结果本组患者有系统性红斑狼疮病史者4例，发热20例，头痛19例，精神异常13例，癫痫发作12例，意识障碍10例，偏瘫2例；所有患者血免疫学检查均提示处于狼疮活动期，均行头颅磁共振检查，其中17例可见单发或多发局灶性病灶，表现为斑片状长T1长T2异常信号，无占位效应，增强后无强化，治疗后病灶可缩小或消失。结论系统性红斑狼疮性脑病的临床表现以发热、头痛、精神异常、癫痫发作和意识障碍常见，头颅磁共振结合血免疫学检查有助于早期诊断，早期治疗预后较好。

Objective To explore the clinical characteristics of neuropsychiatric systemic lupus erythema- tosus （NPSLE）. Methods Retrospective analysed the clinical data of 21 patients with NPSLE. Patients were treated with hormone therapy, maintaining 1 a-2 a, while giving anti-inflammatory, inhibition of cer ebral edema, improve cerebral blood circulation and improve brain cell metabolism drug applications. Results 4 patients had a history of systemic lupus erythematosus （SLE） , 20 patients of fever, 19 cases of headache, 13 cases of psychosis, 12 cases of seizures, 10 cases of conscious disturbance, 2 cases of limb paralysis. Blood immunological examination were prompted all patients being in the lupus activity. The 21 patients underwent cranial MRI examination, of which 17 cases were observed with single or multiple focal lesions. The image showed patchy long T1 and long T2 signal abnormalities, no placeholder effect, no enhancement after strengthening. And lesions can be reduced or disappeared after treatment. Conclusion The clinical symptoms of NPSLE are most common in fever, headache, psychosis, seizures and conscious disturbance. Blood immunological test combined with cranial MRI are helpful for the early diagnosis of NPSLE, and the early treatment is beneficial for the prognosis of NPSLE.