系统性红斑狼疮合并横贯性脊髓炎6例分析  

Clinical analysis of 6 cases of systemic lupus erythematosus complicated by transverse myelitis

作　　者：谭立夫 李昊[2] 梁柳琴[2] 詹钟平[2] 连帆[2] 

机构地区：[1]惠阳区人民医院内五科,广东惠州516211 [2]中山大学附属第一医院风湿免疫科,广东广州510080

出　　处：《南方医科大学学报》2011年第2期313-316,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2008B080703015)

摘　　要：目的总结系统性红斑狼疮(SLE)合并横贯性脊髓炎(TM)的临床特点及治疗方法,以期提高对本病的认识。方法回顾性分析6例SLE合并TM患者的临床特征、实验室检查、治疗方法,并复习文献。结果 6例患者中女性5例,男性1例,发病年龄14～36岁,平均年龄23岁;从有SLE症状开始至TM发病的时间1～13个月,平均8个月。所有患者均有双下肢乏力,其中3例合并双上肢乏力。6例行脊髓MRI检查,病变位于颈髓2例,胸髓3例,颈、胸、腰髓同时受累1例。脑脊液检查无特征性提示。5例予大剂量甲基泼尼松龙(MP)+环磷酰胺(CTX)冲击治疗,1例予MP 80 mg/d+CTX治疗。经治疗后,3例症状完全缓解,2例症状明显减轻,1例肌力改善不明显。结论 SLE合并TM比较少见,多见于相对年轻的SLE患者;相对其他并发症而言,多出现在疾病早期,病变位于胸髓较多;早期诊治是改善预后的关键。Objective To summarize the clinical features and therapeutic approach of systemic lupus erythematosus（SLE） complicated by transverse myelitis（TM）.Methods The clinical characteristics,laboratory examinations,treatment and prognosis of 6 SLE cases with TM were retrospectively analyzed with review of the literatures.Results The 6 patients consisted of 5 females and 1 male aged 14 to 36 years（mean 23 years）.The mean duration from symptom onset of SLE to TM was 8 months（1 to 13 months）.All the patients had lower limb hypodynamia,and 3 of them developed upper limb hypodynamia.MRI scanning of the spine identified lesions in the cervical spinal cord in 2 cases,thoracic lesions in 3 cases,and multiple involvement of the cervical,thoracic and lumbar cord in 1 case.Examination of the cerebrospinal fluid yielded no specific findings except for leukocytosis in 1 case and hypoglycemia in another.Five cases were treated with high-dose MP＋CTX,and the other case was treated with MP（80 mg/day）＋CTX.Five patients responded favorably to the treatment,while the other showed no obvious improvement.Conclusion TM is a rare complication of SLE affecting mostly young patients and occurring in the early stage of the disease.Early diagnosis and aggressive treatment might improve the prognosis.

关 键 词：系统性红斑狼疮 横贯性脊髓炎 合并症 甲基泼尼松龙 环磷酰胺 

分 类 号：R593.241[医药卫生—内科学] R745.4[医药卫生—临床医学]