系统性红斑狼疮合并中枢神经系统感染与神经精神性狼疮的临床区别  

Clinical differences between central nervous system infection and neuropsychiatric lupus in patients with systemic lupus erythematosus

作　　者：冯学兵[1] 周康兴[1] 丁从珠[1] 孙凌云[1] 

机构地区：[1]南京大学医学院附属鼓楼医院风湿免疫科,210008

出　　处：《中华风湿病学杂志》2010年第3期188-191,共4页Chinese Journal of Rheumatology

摘　　要：目的了解系统性红斑狼疮（SLE）患者发生中枢神经系统（CNS）感染与神经精神性狼疮（NPSLE）的临床区别。方法回顾分析既往4年收治的12例合并CNS感染的SLE住院患者临床表现、实验室检查和预后情况，和同期收治的15例中枢性NPSLE住院患者进行对比分析，采用两样本均数的t检验，Mannwhitnev检验和Fisher确切概率法进行统计学处理。结果12例合并CNS感染的SLE患者中女性10例占83％，平均发病年龄（37±4）岁。与NPSLE患者[SLE疾病活动指数（SLEDAI）（14．3±1．6）]相比，合并CNS感染的SLE患者SLEDAI（6．4±1．2），狼疮活动性低（P〈0．01），而发病前糖皮质激素用量大[（28.3±2．5）mg/d与（8．4±3．0）mg/d]（P〈O．01），应用免疫制剂者多（83％与33％，P〈0．05）。合并CNS感染的SLE患者临床症状以头痛、发热最为常见（P〈0．01），其血清白蛋白水平[（34．2±1．2）g／L]高于对照组[（29．9±1．6）g，L]（P〈0．05）；脑脊液检查显示，这些患者白细胞数显著升高[（326±104）／ul与（5±3）／ul，P〈0．01]，糖含量显著降低[（1．38±0．27）mmol/L与（3．47±0．29）mmol/L，P〈0．01]，蛋白水平[（1246±155）mg／L]亦较对照组[与（669±206）mg／L]增高（P〈0．05）。结论SLE患者发生CNS感染后预后不佳。长期使用大剂量激素和免疫抑制剂者如出现不能解释的头痛、发热症状且狼疮整体活动性不高时，应及时行脑脊液检查排除此病。Objective To identify the clinical differences between central nervous system （CNS） infection and neuropsychiatric lupus in patients with systemic lupus erythematosus （SLE）. Method Clinical manifestations, lab test results and prognosis of 12 SLE patients complicated with CNS infections, hospitalized in Nanjing Drum Tower Hospital in the past four years, were reviewed and compared with those of 15 concomitantly treated patients with central neuropsychiatric lupus （NPL）. Two-indenpendent samples t test, Mann- whitney test and Fisher exact test were used for statistical analysis. Results 83% of SLE patients with CNS infections were female and the average disease onset age was （37±4） years. As compared to neuro-psychiatric lupus patients （the control group）, those patients with CNS infections （infection group） had lower lupus disease activity （SLEDAI score 14.3±1.6 vs 6.4±1.2, P〈0.01 ） and took higher dose of corticosteroids [average prednisone dose （28.3±2.5） vs （8.4±3.0） mg/d, P〈0.01 ] and more immunosuppressives agents （83% vs 33%, P〈0.05） before the occurrence of CNS symptoms. Headache and fever were more common in the infection group （100% vs 46.7% and 91.7% vs 20%, both P〈0.01 ） and simultaneously higher serum albumin levels [ （34.2±1.2） g/L vs （29.9±1.6） g/L] were detected in those patients compared to the NPL patients （P〈0.05）. Cerebrospinal fluid examination showed that there were increased total cell counts [ （326±104）/ul 与（5±3） /ul, decreased glucose levels [ （1.38±0.27） mmol/L vs （3.47±0.29） mmol/L] as well as elevated protein levels [（1246±155） mg/L vs （669±206） mg/L] in patients with CNS infections （P〈0.01, P〈0.01 and P〈0.05）. Conclusion A poor prognosis could be expected when SLE patients develop CNS infections. For those who have been given high dose of corticosteroids and immunosuppressive agents for a long time but without strong evidence of lupus disease activity, CNS infection should

关 键 词：红斑狼疮 系统性 中枢神经系统感染 狼疮血管炎 中枢神经系统 

分 类 号：R593.241[医药卫生—内科学]