系统性红斑狼疮脑病的研究进展

Research progress of systemic lupus erythematosus encephalopathy

系统性红斑狼疮患者常表现出神经系统受累的症状,称为系统性红斑狼疮脑病或神经精神性狼疮。系统性红斑狼疮的神经系统表现多样,通常有非特异性症状,如头痛和认知障碍,但也可能有器质性病变,如癫痫、横贯性脊髓炎和脑卒中等。目前认为这些症状是微血管病变和血栓形成、自身抗体和炎症介质介导的炎症反应等共同促进狼疮脑病发病的结果。系统性红斑狼疮脑病的诊断是临床一重大挑战,且目前无统一标准,需要排除其他病因,结合临床表现和辅助检查共同评估。治疗主要包括对于神经系统症状的对症治疗,以及根据病情评估给与免疫抑制治疗,甚至还需要抗凝治疗,但目前需要进一步深入研究NPSLE的免疫发病机制和可能的靶向药物来提高NPSLE的诊治能力。本文基于NPSLE的发病机制、临床特点、诊断和治疗研究进展等展开讨论并作一综述,希望为临床上的诊治决策提供一定的帮助。

Patients with systemic lupus erythematosus(SLE)often exhibit symptoms of nervous system involvement,known as neuropsychiatric systemic lupus erythematosus(NPSLE).Systemic lupus erythematosus has diverse neurological manifestations,often with non⁃specific symptoms such as headache and cognitive impairment,but may also have organic lesions such as epilepsy,transverse myelitis,and stroke.These symptoms are currently considered to be the result of the promotion of lupus encephalopathy by microvascular disease and thrombosis,auto⁃antibodies and inflammatory mediator⁃mediated inflammatory responses.The diagnosis of NPSLE is a major clinical challenge,and there is currently no uniform standard.Other causes need to be excluded,combined with clinical manifestations and auxiliary examinations.Treatment consists primarily of symptomatic treatment of neurological symptoms,as well as immunosuppressive therapy based on condition assessment,and even anticoagulant therapy,as well as more specific protocol development using anticoagulants or immunosuppressive agents based on the primary immune pathogenesis.However,it is necessary to further study the immune pathogenesis of NPSLE and possible targeted drugs to improve the diagnosis and treatment of NPSLE.This article is based on the research on the pathogenesis,clinical features,diagnosis and treatment progress of NPSLE,and hopes to provide some help for clinical diagnosis and treatment decision⁃making.