系统性红斑狼疮伴神经精神异常16例临床分析

Clinical analysis of 16 cases about systemic lupus erythematosus patients with nerval or mental abnormity

目的 探讨狼疮脑病的临床表现、鉴别诊断与治疗。方法 回顾性分析 16例出现神经精神异常的系统性红斑狼疮(SLE)患者的临床表现、实验室检查、治疗和转归。结果 16例患者在激素治疗的各个阶段分别出现精神障碍、昏迷、癫痫、脑出血、脑梗死、截瘫、中枢神经系统感染 ,其中 13例患者临床处于狼疮活动期 (包括 1例合并结核性脑膜炎 ,1例合并高血压病 ) ,其余 3例狼疮活动均趋向稳定 (包括 1例合并癔症 ,2例激素减量后好转 )。经激素、CTX、鞘注、血浆置换、输丙球、抗感染、脱颅压等处理 ,除 1例死亡外 ,其余患者均有不同程度的缓解。结论 狼疮脑病临床表现多样 ,需要排除许多继发因素导致脑损害后方可诊断 。

AIM To investigate the clinic, distinguishing, and treatment of lupus encephalopathy. METHODS Retrospective analysis was done in 16 patients whose final diagnosis was SLE associated with nerval or mental abnormity. The analysis included the clinical characteristic, the examination of lab, the treatment and the prognosis. RESULTS In every stage of hormone treatment,the 16 patients separately behaved mental obstacle,coma,falling sickness,cerebral hemorrhage,cerebral infarct, paraplegia,infection of central nerve system.The lupus states of 13 patients among them were up and doing,including 1 case incorporating tubercular meningitis and 1 case incorporating hypertensive illness. The lupus states of the other 3 cases were steadying,including 1 case incorporating hysteria and 2 cases straightening up after the dosage of hormone was decreased except 1 patient died,other patients all straightened up corresponding to their states by using hormone and CTX,injecting drugs into CSF, permuting the blood plasma,inputing globulin,resisting infection,reducing the pressure of brain and etc. CONCLUSIONS The clinical behavior of lupus encephalopathy is various.we can't diagnose lupus encephalopathy unless we eliminate the possibillily that many other factors hurt the brain. Early diagnosis and accurate cure are the key to reduce the rate of death and deformity.