狼疮脑病患者核磁下的脑萎缩、皮质受累和限制扩散可能是病情活动标志

作者：Wang HP , et al.

翻译：北医三院张警丰

摘要：目的：核磁检查（MRI）是评估神经精神狼疮（NPSLE）的一种常用的神经系统影像学检查方法。本研究的目的是评估女性NPSLE患者临床及免疫学特点与MRI异常之间的关系，进一步评估MRI在NPSLE中的价值。

方法：本研究为回顾性研究，共纳入59例女性接受过MRI检查的NPSLE患者。根据核磁结果的异常将患者分为不同的组别。评估MRI正常与异常组的临床及免疫学特点。应用单向方差分析法比较系统性红斑狼疮活动指数（SLEDAI）与MRI异常之间的关系。多因素回归分析用以判断免疫学异常、神经精神症状和MRI异常之间的关系。

结果：36例NPSLE患者（61%）MRI结果异常。MRI异常组与正常组相比，SLEDAI评分（P＜0.001）、神经系统异常发生率(P = 0.001)、24小时尿蛋白水平(P = 0.001)、免疫球蛋白M (P = 0.004)、急性精神混乱发生率(P = 0.002)、脑血管疾病(P = 0.004)以及癫痫发作(P = 0.028)均具有显著差异。核磁异常组与核磁正常组相比，脑萎缩（CA）、皮质受累和限制扩散（RD）均显著增高，P值分别为< 0.001,="0.002," ="0.038。统计发现癫痫发作和皮质受累显著正相关(odds" ratio [or]="14.90;" 95% 置信区间[ci], 1.50-151.70; p="0.023)，脑血管意外和小脑幕下受累显著正相关(OR" ="10.00;" 95% ci, 1.70-60.00; p="0.012)。

结论：NPSLE的核磁异常，尤其是脑萎缩、皮质受累和限制扩散可能是系统性红斑狼疮疾病活动的标志。某些核磁异常与神经精神症状相关，可能对于理解NPSLE的病理生理机制有益。

附原文：Abstract：BACKGROUND:Conventional magnetic resonance imaging (MRI) is the preferred neuroimaging method in the evaluation of neuropsychiatric systemic lupus erythematosus (NPSLE). The purpose of this study was to investigate the association between clinical and immunological features with MRI abnormalities in female patients with NPSLE, to screen for the value of conventional MRI in NPSLE.METHODS:A total of 59 female NPSLE patients with conventional MRI examinations were enrolled in this retrospective study. All patients were classified into different groups according to MRI abnormalities. Both clinical and immunological features were compared between MRI abnormal and normal groups. One-way analysis of variance was used to compare the systemic lupus erythematosus disease activity index (SLEDAI) score for MRI abnormalities. Multivariate logistic regression analysis investigated the correlation between immunological features, neuropsychiatric manifestations, and MRI abnormalities.RESULTS:Thirty-six NPSLE patients (61%) showed a variety of MRI abnormalities. There were statistically significant differences in SLEDAI scores (P < 0.001), incidence of neurologic disorders (p="0.001)," levels of 24-h proteinuria (p="0.001)" and immunoglobulin m (p="0.004)," and incidence of acute confusional state (p="0.002)," cerebrovascular disease (p="0.004)," and seizure disorder (p="0.028)" between mri abnormal and normal groups. in the mri abnormal group, sledai scores for cerebral atrophy (ca), cortex involvement, and restricted diffusion (rd) were much higher than in the mri normal group (p < 0.001, p="0.002," p="0.038," respectively). statistically significant positive correlations between seizure disorder and cortex involvement (odds ratio [or]="14.90;" 95% confidence interval [ci], 1.50-151.70; p="0.023)" and cerebrovascular disease and infratentorial involvement(or="10.00;" 95% ci, 1.70-60.00; p="0.012)" were found.conclusions:mri abnormalities in npsle, especially ca, cortex involvement, and rd might be markers of high systemic lupus erythematosus activity. some mri abnormalities might correspond to neuropsychiatric manifestations and might be helpful in understanding the pathophysiology of npsle.

引自：Wang HP, Wang CY, Pan ZL,et al. Relationship Between Clinical and Immunological Features with Magnetic Resonance Imaging Abnormalities in Female Patients with Neuropsychiatric Systemic Lupus Erythematosus. Chin Med J (Engl). 2016 Mar 5;129(5):542-8.