系统性红斑狼疮患者认知功能障碍及相关危险因素  

Cognitive impairment and related risk factors in systemic lupus erythematosus patients

作　　者：范洋溢[1] 李春[2] 沈明[1] 彭莉[1] 高旭光[1] FAN Yangyi;LI Chun;SHEN Ming;PENG Li;GAO Xuguang(Department of Neurology,Peking University People's Hospital,No.11 Xizhimen South Street,Xicheng District,Beijing 100044,China)

机构地区：[1]北京大学人民医院神经内科,北京100044 [2]北京大学人民医院风湿免疫科

出　　处：《中国神经精神疾病杂志》2019年第12期715-720,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的研究系统性红斑狼疮(systemic lupus erythematosus,SLE)患者认知功能障碍(cognitive impairment,CI)的情况及其相关危险因素。方法2018年6月至2019年1月纳入SLE患者47例,健康对照组24例。用简易智能量表评分(mini-mental state examination,MMSE)、蒙特利尔认知量表评分(montreal cognitive assessment,MoCA)以及词语学习测验(hopkins verbal learning test,HVLT)、词语流畅性测验(verbal fluency test,VFT)、数字广度测验(digit span test,DST)、符号数字模式测验(symbol digit modalities test,SDMT)、连线测验(trail making test,TMT)和Stroop色词测验(stroop color-word test,SCWT)进行知功能评估;结合临床和实验室资料分析SLE患者认知功能障碍的危险因素。结果SLE组和正常对照在MMSE评分[29(28,30)vs.30(29,30)]、MoCA评分(25.4±3.7 vs.28.2±1.2)以及HVLT(三试:21.7±6.1 vs.25.7±2.6;延迟回忆:7.3±2.5 vs.9.8±1.8)、SDMT(41.7±14.4 vs.56.3±9.9)、SCWT时间(A:27.0±8.0 vs.23.1±2.8;B:37.0±17.2 vs.30.0±3.4;C:72.6±26.7 vs.52.5±8.5)中与正常对照存在统计学差异(P<0.05);SLE患者中CI者(29/47,61.7%)与无CI者(18/47,38.3%)在年龄、病程、疾病活动度以及血清学抗体检查方面无统计学差异,但神经精神狼疮(neuropsychiatric systemic lupus erythematosus,NPSLE)的比例高于无CI者(44.8%vs.16.7%,P=0.046)。结论SLE患者易出现CI,在记忆、注意力、心理运动速率及执行功能方面更为突出,精神神经狼疮是SLE患者CI的危险因素。Objective To investigate the cognitive abilities of systemic lupus erythematosus(SLE)patients and explore the risk factors for cognitive impairment(CI).Methods From June,2018 to January 2019,47 patients with SLE and 24 healthy controls were subjected to Mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and a series of neuropsychological tests recommended by the American College of Rheumatology(ACR)including Hopkins Verbal Learning Test(HVLT),Verbal Fluency Test(VFT),Digit Span Test(DST),Symbol Digit Modalities Test(SDMT),Trail Making Test(TMT)and Stroop Color-Word Test(SCWT).The clinical characters and tests of antibodies were also recorded and analyzed.Results Compared with normal controls,SLE patients exhibited poorer performance in the MMSE[29(28,30)vs.30(29,30)],MoCA(25.4±3.7 vs.28.2±1.2),HVLT(3-trails:21.7±6.1 vs.25.7±2.6;delayed recall:7.3±2.5 vs.9.8±1.8),SDMT(41.7±14.4 vs.56.3±9.9)and SCWT time(A:27.0±8.0 vs.23.1±2.8;B:37.0±17.2 vs.30.0±3.4;C:72.6±26.7 vs.52.5±8.5)tests.Twenty-nine of 47 SLE patients had cognitive impairment.There were no significant differences between the CI group and the no-CI group in age,education,disease duration,SLE disease activity index(SLEDAI)and the levels of antibodies,while the CI group had a higher incidence of neuropsychiatric systemic lupus erythematosus(NPSLE)than the no-CI group(44.8%vs.16.7%,P=0.046).Conclusion Memory,attention,psychomotor speed and executive abilities are more frequently affected cognitive domains in SLE patients.The clinical characters and immunological status of CI patients do not differ with that of the no-CI ones except for the history of NPSLE.

关 键 词：系统性红斑狼疮 认知功能障碍 神经精神狼疮 

分 类 号：R593.24[医药卫生—内科学] R747.9[医药卫生—临床医学]