神经精神性狼疮临床亚型与影像学表现及自身抗体相关性分析

Correlation between clinical and imaging findings and autobody levels in patients with neuropsychiatric systemic lupus erythematosus

目的 神经精神性狼疮(NPSLE)临床表现多样,分为多种亚型。本文总结NPSLE及其亚型的神经影像、血清免疫学表现,探讨临床亚型与影像学表现及自身抗体之间的相关性。方法 采集2010年1月1日-2017年12月31日期间首都医科大学宣武医院住院NPSLE患者的临床、神经影像学资料及免疫学指标,总结NPSLE及其各亚型的神经影像、血清免疫学表现,分析NPSLE各临床亚型与特定影像学表现及自身抗体之间的相关性。结果 本文34例NPSLE患者临床及影像学表现多样,最常见NPSLE症状为认知障碍(23.5%)、头痛(14.7%);最常见头颅MRI表现为小血管病变(50.0%)及炎性病变(47.1%)。认知障碍及急性精神混乱状态与头颅MRI出现炎性病变显著相关(P<0.05);NPSLE急性脑血管病与血清抗磷脂抗体阳性显著相关(P<0.05)。结论 NPSLE临床、影像表现多样。认知障碍及急性精神混乱状态与头颅MRI出现炎性病变相关。NPSLE急性脑血管病与血清抗磷脂抗体相关。

Objective Neuropsychiatric systemic lupus erythematosus( NPSLE) encompasses a wide spectrum of neurologic and psychiatric disorders. The neuropsychiatric manifestations can be divided into multiple subtypes. This study aims to describe neuroimaging abnormalities and autobody profile of patients with NPSLE and correlate them with clinical subtypes. Method Patients with NPSLE in Xuanwu Hospital were included between January 1st 2010 to December 31st 2017. Clinical features, neuroimaging, and immunological data were recorded and summarized per NPSLE subtypes. The correlation between clinical subtypes and imaging findings and autobody levels were analyzed. Results 34 patients with NPSLE presented heterogeneous clinical manifestations and imaging findings. The most common neuropsychiatric symptoms were cognitive impairment( 23.5%) and headache( 14.7%). The most common brain MRI abnormalities were lesions of cerebral small vessel disease( 50.0%) and inflammatory lesions( 47.1%). Statistically significant positive correlations between cognitive impairment and acute confusion state and MRI inflammatory lesions were found( P<0.05). Statistically significant positive correlations between acute cerebral vascular disease of NPSLE and serum anti-phospholipid antibody were found( P<0.05). Conclusion The clinical and neroimaging manifestations of NPSLE were heterogeneous. Inflammatory lesions on MRI might be correlated with cognitive impairment and acute confusion state. Serum anti-phospholipid antibody might be correlated with acute cerebral vascular disease of NPSLE.