神经精神性红斑狼疮归因诊断

Attribution diagnosis of neuropsychiatric systemic lupus erythematosus

神经精神性红斑狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)是系统性红斑狼疮(systemic lupus erythematosus,SLE)患者常见并发症并成为影响SLE预后的主要因素之一。NPSLE发病机制未明,临床表现复杂多样,早期诊断和治疗仍面临严重挑战。近年来针对NPSLE归因诊断模型的相关研究越来越多,基于1999美国风湿病学会发布的NPSLE定义分类标准,当前开发的认知度较好的归因诊断模型包括Ainiala定义标准、系统性红斑狼疮国际临床协作组(Systemic Lupus International Collaborating Clinics,SLICC)分类标准模型、Monov和Monova简化模型、意大利风湿病学会(Italian Society of Rheumatology,SIR)算法模型、多学科二次评估和多态模型等,但这些模型各有优缺点,至目前为止尚缺乏公认统一的归因诊断标准,NPSLE归因诊断的金标准仍是基于临床医生的经验判断,引入不断发展的影像学技术将可能是未来优化NPSLE归因诊断的重要方向。

Neuropsychiatric systemic lupus erythematosus(NPSLE)is a common complication and a main risk factor affecting the prognosis of systemic lupus erythematosus(SLE).The unclear pathogenesis and diverse manifestations make the greatest challenge to early diagnosis and treatment of NPSLE.Recently,more studies have paid attention to diagnostic attribution of NPSLE.Based on the American College of Rheumatology(ACR)nomenclature and case definitions for NPSLE in 1999,several established models included Ainiala revised definition criteria,the Systemic Lupus International Collaborating Clinics(SLICC)classification criteria,the Monov and Monova simplified model,the Italian Society of Rheumatology(SIR)algorithm,multidisciplinary reassessment and multistate model,etc.Although these models have their merits and demerits,there is yet no diagnostic standard consensus.Currently,the gold standard of NPSLE classification remains on a clinician's empirical judgment.The introduction of imaging to diagnostic attribution will be important research field for the optimization of NPSLE diagnosis in the future.