系统性红斑狼疮并发脊髓炎六例临床分析并文献复习  

Myelitis in systemic lupus erythematosus： six cases report and review of the literature

作　　者：杨文浩[1] 崔刘福[1] 舒荣[1] 王守红[2] 宋海澄[1] 韩依轩[1] 于萍[1] 王健[1] 王洁蕊[1] 袁伟[1] 刘白鹭[1] 李娜[1] 

机构地区：[1]河北联合大学附属开滦总医院风湿免疫科,唐山063000 [2]河北联合大学附属开滦总医院核磁共振室,唐山063000

出　　处：《中华风湿病学杂志》2015年第3期165-169,I0002,共6页Chinese Journal of Rheumatology

摘　　要：目的分析SEE合并不同类型脊髓炎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合并脊髓炎（横贾性脊髓炎和纵向性脊髓炎各3例）患者的临床特征、辅助检查、治疗方法，并复习文献。结果6例患者均为女性，发病年龄20～52岁，平均（38±12）岁；SLE病程为1个月至5年，平均29个月。所有患者均有下肢乏力，3例纵向性脊髓炎中2例以神经系统症状首发。脊髓核磁共振检查发现所有患者均存在胸髓受累1例，颈髓受累1例，腰髓受累1例，3例纵向性脊髓炎患者受累节段均超过4个脊髓节段。3例患者脑脊液葡萄糖减低，2例患者抗心磷脂抗体阳性。所有患者均给予大剂量甲泼尼龙＋环磷酰胺冲击治疗，2例接受氟美松＋甲氨蝶呤鞘内注射，2例给予静脉注射免疫球蛋白（IVIG）治疗。经治疗后，3例横贯性脊髓炎患者恢复较好，3例纵向性脊髓炎患者中1例无效，2例短期复发。结论SLE脊髓炎存在横贯性和纵向性2种类型；纵向性脊髓炎以神经系统首发多见，抗心磷脂抗体和脑脊液葡萄糖减低与之相关；常规治疗在纵向性脊髓炎中效果不佳。Objective To analyze the clinical features of myelitis in systemic lupus erythematosus （SLE）. Methods The clinical features, laboratory examinations, treatment and prognosis of 6 patients with myelopathy in SLE were described. Results The median onset age of the 6 patients was （38±12） years old （20-52 years of age）. The mean duration from symptom onset of SLE to myelitis was 29 months （1 month to 5 years）. All patients had lower limb hypodynamia. In 3 cases with longitudinal myelitis （LM）, the involved lesions of the spine were more than four segments. Two patients presented with neurological manifestations as the first symptom of SLE. Magnetic resonance imaging （MRI） showed longitudinal or speckle lesions. The lesions of the spine were located at the thoracic region in 5 cases. Four patients had cervical spinal cord involvement. The specific laboratory parameters included anti-phospholipid antibody （positive in 3 cases） and low glucose level in cerebral spinal fluid （3 cases, all of them were LM）. All patients were treated with i.v. pulses methylprednisolone and cyclosphosphamide. The good response to treatment was achieved in all 3 cases with transverse myefitis（TM）. Three cases with LM had poor prognosis, 2 cases relapsed after three months, 1 case showed no improvement at all. Conclusion Transverse and longitu-dinal myehtis are two forms of myelitis in SLE. The presence of aPL and low glucose level in cerebral spinal fluid can be associated with LM. The prognosis of LM is poor.

关 键 词：红斑狼疮 系统性 脊髓炎 疾病特征 

分 类 号：R593.241[医药卫生—内科学]