伴有肾功能受损的系统性红斑狼疮患者脑小血管病影像学特征及其相关危险因素分析

Imaging features of cerebral small vessel disease in systemic lupus erythematosus patients with impaired renal function and its associated risk factors

目的 探讨伴有肾功能受损的系统性红斑狼疮（SLE）患者脑小血管病（SVD）的影像特征以及相关危险因素.方法 纳入2014年5月至2016年8月就诊的76例SLE患者和40名年龄、性别匹配的健康志愿者,根据估算的肾小球滤过率（eGFR）将SLE患者分为肾功能受损组[eGFR〈90 ml/（min·1.73 m2）]38例和肾功能正常组[eGFR≥90 ml/（min·1.73 m2）]38例.对所有对象行MR检查及神经心理学量表测试,收集SLE患者的临床生化指标,并对MR图像进行脑小血管病量化评分.采用有序logistic回归分析SVD评分的危险因素.结果 伴有肾功能受损的SLE患者组与健康对照组、肾功能正常SLE患者组在基底节区血管周围间隙（PVS）、半卵圆中心PVS、脑室旁白质高信号（WMH）、深部WMH及总SVD分数差异均有统计学意义（H值分别为44.568、31.380、31.172、43.419、24.317,P〈0.001）.等级logistic回归分析显示C反应蛋白是SLE患者脑小血管病的危险因素（OR=1.323,P〈0.01）.结论 肾功能受损的SLE患者脑小血管病明显增加,主要以基底节区PVS、深部WMH为著,且受患者C反应蛋白水平的影响.

Objective To investigate the imaging features of cerebral small vessel disease（SVD） in systemic lupus erythematosus（SLE） patients with impaired renal function and their related risk factors. Methods Seventy-six SLE patients and forty age-and sex-matched healthy controls were recruited, and SLE patients were divided into the impaired renal function group [estimated glomerular filtration rate （eGFR） 〈90 ml/（min·1.73 m2）] （n=38） and the normal renal function group [eGFR≥90 ml/（min·1.73 m2）] （n=38） according to their eGFR. All subjects underwent brain MRI, cognitive and psychiatric testing. The SVD scores were measured, total white matter hyperintensity （WMH） and SVD scores were calculated, and the risk factors of SVD scores were analyzed by using ordinal logistic regression. Results SLE patients in the impaired renal function group showed higher basal ganglia PVS, centrum semiovale perivaseular space （PVS）, periventricular WMH, deep WMH and total SVD scores compared with normal controls or patients with normal renal function （H=44.568, 31.380, 31.172, 43.419, 24.317, P〈0.001）. The ordinal logistic regression analysis showed that C-reactive protein was a risk factor for SVD in patients with SLE（OR= 1.323, P〈0.01）. Conclusion SLE patients with impaired renal function had a higher SVD burden on MR imaging, particularly PVS in the basal ganglia and deep WMH, which was affected by the C-reactive protein level.