脑动脉微栓子检测在神经精神狼疮诊断中的价值  

The value of microemboli detection in cerebral arteries for the diagnosis of neuropsychiatric lupus

作　　者：章璐[1] 孙丽丽[2] 郭静[2] 江薇[1] 李嗣钊[1] 焦劲松[2] 王国春[1] 

机构地区：[1]中日友好医院风湿免疫科,北京100029 [2]中日友好医院神经内科,北京100029

出　　处：《中华风湿病学杂志》2015年第12期829-833,共5页Chinese Journal of Rheumatology

基　　金：中日友好医院青年科技英才计划（2014-QNYC-B-11,2014-QNYL-A-03）

摘　　要：目的通过经颅多普勒（TCD）检测SLE患者脑动脉微栓子信号（MES），并探讨MES与神经精神狼疮（NPSLE）临床特点的相关性。方法根据纳入和排除标准选取44例SLE患者进行MES检测，记录临床资料。评价微栓子出现的情况和MES阳性病例的临床特征。同时MES阳性患者于6个月后复查MES检测。采用Mann—WhitneyU检验和Fisher确切概率法进行分析。结果4例患者既往有神经精神狼疮病史（NPSLE），NPSLE发生时间距本研究时间为8-120个月。同时，共有4例患者在纳入本研究中有神经精神症状。共有5例（11％）女性患者检测到MES信号，平均数量为17．6个，强度9。29dB。MES阳性患者（5例）较MES阴性患者（39例）SLEDAI评分更高[16（12．5，19）与8（5，10），U=14．5，P=0．001]，病程更短[1（0．1，48．5）与26（13，55），U=38，P=0．028]，伴有神经精神症状的病例数较多[3例与1例，P=0．003]。结论SLE患者颅内可以检测到MES信号。MES阳性患者的SLE病情活动性更高，病程相对较短。MES阳性与SLE患者神经精神症状有一定的相关性。临床上对怀疑NPSLE患者常规检测MES有助于病情判断。Objective To determine the prevalence of microembolic signals （MES） by using tran- scranial Doppler （TCD） and to assess their association with neuropsychiatric systemic lupus erythematosus （NPSLE1 and clinical presentations in patients with systemic lupus erythematosus （SLE）. Methods Forty-four patients with SLE underwent TCD for 30 min were included for MES detection and their clinical information were recorded. In addition to the frequency of patients with MES, patients with MES were followed-up for six-month. Mann-Whitney U test and Fisher exact test were applied to investigate the clinical characteristics. Results There were 4 patients with history of NPSLE and the occurrence times were from 8 to 120 month before our study. There were 4 patients had the abnormal neuropsychiatric symptom during our study period. MES were detected in 5/44 patients （11%） with mean 17.6 per 30 min. MES were more prone to be detected in patients with higher systemic lupus erythematosus disease activity index （SLEDAI） score [16 （12.5, 19） vs 8（5, 10）, U=14.5, P=0.001], shorter course of disease [1 （0.1, 48.5） vs 26（13, 55）, U=38, P=0.028] and neuropsychiatric symptoms [3 vs 1, P=0.003]. Conclusion MES may be detected in SLE patients. MES is associated with higher disease activity, shorter course of disease and NPSLE. TCD microemboli detection may be a noninvasive method to evaluate NPSLE patients.

关 键 词：红斑狼疮 系统性 神经精神狼疮 经颅多普勒 微栓子信号 

分 类 号：R593.241[医药卫生—内科学]