核磁下的脑萎缩、皮质受损及限制扩散成像可能是狼疮活动度高的指标

作者：Hai-Peng Wang 翻译：北医三院李欣艺

摘要: 背景：传统的核磁检查是评估狼疮脑病优选的神经影像学方法。此研究旨在探讨狼疮脑病患者中头颅核磁异常表现与临床表现、自身免疫性特点之间的关系，从而探讨传统核磁在狼疮脑病诊治中的价值。

方法：共59名经过传统核磁共振检查的女性狼疮患者纳入回顾性分析研究。病人根据头颅核磁异常表现划分为不同组。核磁表现正常组及异常组均进行临床表现及自身免疫性特点比较分析。采用单项方差分析计算核磁异常患者狼疮活动评分。采用多变量逻辑回归分析探讨自身免疫性特点、神经表现以及核磁异常表现之间的关系。

结果：36名患者表现出头颅核磁的异常。这些异常在狼疮活动度评分中有明显的统计学不同：神经系统紊乱（P=0.001）、24小时尿蛋白（P=0.001）、Ig-M（P=0.004）、急性精神错乱（P=0.002）、脑血管疾病（P=0.004）、癫痫（P=0.028）。核磁异常组的脑萎缩、皮质受损及限制扩散成像发生频率，要比核磁正常组高。癫痫、皮质受损以及脑血管疾病、小脑幕受损等表现有统计学意义。

结论：核磁异常表现，尤其是脑萎缩、皮质受损及限制扩散成像均是高狼疮活动度评分的预测指标。一些核磁异常表现或许与神经系统表现相平行，或许在探讨狼疮脑病发病机制中有重要作用。

附原文：Background: Conventional magnetic resonance imaging (MRI) is the preferred neuroimaging method in the evaluation of neuropsychiatric systemic lupus erythematosus (NPSLE). The purpose of this study was to investigate the association between clinical and immunological features with MRI abnormalities in female patients with NPSLE, to screen for the value of conventional MRI in NPSLE. Methods: A total of 59 female NPSLE patients with conventional MRI examinations were enrolled in this retrospective study. All patients were classified into different groups according to MRI abnormalities. Both clinical and immunological features were compared between MRI abnormal and normal groups. One-way analysis of variance was used to compare the systemic lupus erythematosus disease activity index (SLEDAI) score for MRI abnormalities. Multivariate logistic regression analysis investigated the correlation between immunological features, neuropsychiatric manifestations, and MRI abnormalities. Results: Thirty-six NPSLE patients (61%) showed a variety of MRI abnormalities. There were statistically significant differences in SLEDAI scores (P < 0.001), incidence of neurologic disorders (P = 0.001), levels of 24-h proteinuria (P = 0.001) and immunoglobulin M (P = 0.004), and incidence of acute confusional state (P = 0.002), cerebrovascular disease (P = 0.004), and seizure disorder (P = 0.028) between MRI abnormal and normal groups. In the MRI abnormal group, SLEDAI scores for cerebral atrophy (CA), cortex involvement, and restricted diffusion (RD) were much higher than in the MRI normal group (P < 0.001, P = 0.002, P = 0.038, respectively). Statistically significant positive correlations between seizure disorder and cortex involvement (odds ratio [OR] = 14.90; 95% confidence interval [CI], 1.50–151.70; P = 0.023) and cerebrovascular disease and infratentorial involvement (OR = 10.00; 95% CI, 1.70–60.00; P = 0.012) were found. Conclusions: MRI abnormalities in NPSLE, especially CA, cortex involvement, and RD might be markers of high systemic lupus erythematosus activity. Some MRI abnormalities might correspond to neuropsychiatric manifestations and might be helpful in understanding the pathophysiology of NPSLE.

Chin Med J (Engl). 2016 Mar 5; 129(5): 542–548.

引自：Hai-Peng Wang, Cui-Yan Wang, Zheng-Lun Pan, Jun-Yu Zhao, and Bin Zhao Relationship Between Clinical and Immunological Features with Magnetic Resonance Imaging Abnormalities in Female Patients with Neuropsychiatric Systemic Lupus Erythematosus Chin Med J (Engl). 2016 Mar 5; 129(5): 542–548.