中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2010年
3期
188-191
,共4页
冯学兵%周康兴%丁从珠%孙凌云
馮學兵%週康興%丁從珠%孫凌雲
풍학병%주강흥%정종주%손릉운
红斑狼疮,系统性%中枢神经系统感染%狼疮血管炎,中枢神经系统
紅斑狼瘡,繫統性%中樞神經繫統感染%狼瘡血管炎,中樞神經繫統
홍반랑창,계통성%중추신경계통감염%랑창혈관염,중추신경계통
Lupus erythematosus,systemic%Central nervous system infections%Lupus vasculitis,central neurvous system
目的 了解系统性红斑狼疮(SLE)患者发生中概神经系统(CNS)感染与神经精神性狼疮(NPSLE)的临床区别.方法 回顾分析既往4年收治的12例合并CNS感染的SLE住院患者临床表现、实验室检查和预后情况.和同期收治的15例中枢性NPSLE住院患者进行对比分析,采用两样本均数的t检验,Mannwhitney检验和Fisher确切概率法进行统计学处理.结果 12例合并CNS感染的SLE患者中女性10例占83%,平均发病年龄(37±4)岁.与NPSLE患者ISLE疾病活动指数(SLEDAI)(14.3±1.6)]相比,合并CNS感染的SLE患者SLEDA1(6.4±1.2),狼疮活动性低(P<0.01),而发病前糖皮质激素用量大[(28:3±2.5)mg/d与(8.4±3.0)mg/d](P<0.01),应用免疫制剂者多(83%与33%,P<0.05.合并CNS感染的SLE患者临床症状以头痛、发热最为常见(P<0.01),其血清白蛋白水平[(34.2±1.2)g/L]高于对照组[(29.9±1.6)g/L](P<0.05);脑脊液检查显示,这些患者白细胞数显著升高[(326±104)/μl与(5±3)/μl,P<0.01],糖含量显著降低[(1.38±0.27)mmol/L与(3.47±0.29)mmol]L,P<0.01],蛋白水平[(1246±155)mg/L]亦较对照组[与(669±206)mg/L]增高(P<0.05).结论 SLE患者发生CNS感染后预后不佳.长期使用大剂量激素和免疫抑制剂者如出现不能解释的头痛、发热症状且狼疮整体活动性不高时,应及时行脑脊液检查排除此病.
目的 瞭解繫統性紅斑狼瘡(SLE)患者髮生中概神經繫統(CNS)感染與神經精神性狼瘡(NPSLE)的臨床區彆.方法 迴顧分析既往4年收治的12例閤併CNS感染的SLE住院患者臨床錶現、實驗室檢查和預後情況.和同期收治的15例中樞性NPSLE住院患者進行對比分析,採用兩樣本均數的t檢驗,Mannwhitney檢驗和Fisher確切概率法進行統計學處理.結果 12例閤併CNS感染的SLE患者中女性10例佔83%,平均髮病年齡(37±4)歲.與NPSLE患者ISLE疾病活動指數(SLEDAI)(14.3±1.6)]相比,閤併CNS感染的SLE患者SLEDA1(6.4±1.2),狼瘡活動性低(P<0.01),而髮病前糖皮質激素用量大[(28:3±2.5)mg/d與(8.4±3.0)mg/d](P<0.01),應用免疫製劑者多(83%與33%,P<0.05.閤併CNS感染的SLE患者臨床癥狀以頭痛、髮熱最為常見(P<0.01),其血清白蛋白水平[(34.2±1.2)g/L]高于對照組[(29.9±1.6)g/L](P<0.05);腦脊液檢查顯示,這些患者白細胞數顯著升高[(326±104)/μl與(5±3)/μl,P<0.01],糖含量顯著降低[(1.38±0.27)mmol/L與(3.47±0.29)mmol]L,P<0.01],蛋白水平[(1246±155)mg/L]亦較對照組[與(669±206)mg/L]增高(P<0.05).結論 SLE患者髮生CNS感染後預後不佳.長期使用大劑量激素和免疫抑製劑者如齣現不能解釋的頭痛、髮熱癥狀且狼瘡整體活動性不高時,應及時行腦脊液檢查排除此病.
목적 료해계통성홍반랑창(SLE)환자발생중개신경계통(CNS)감염여신경정신성랑창(NPSLE)적림상구별.방법 회고분석기왕4년수치적12례합병CNS감염적SLE주원환자림상표현、실험실검사화예후정황.화동기수치적15례중추성NPSLE주원환자진행대비분석,채용량양본균수적t검험,Mannwhitney검험화Fisher학절개솔법진행통계학처리.결과 12례합병CNS감염적SLE환자중녀성10례점83%,평균발병년령(37±4)세.여NPSLE환자ISLE질병활동지수(SLEDAI)(14.3±1.6)]상비,합병CNS감염적SLE환자SLEDA1(6.4±1.2),랑창활동성저(P<0.01),이발병전당피질격소용량대[(28:3±2.5)mg/d여(8.4±3.0)mg/d](P<0.01),응용면역제제자다(83%여33%,P<0.05.합병CNS감염적SLE환자림상증상이두통、발열최위상견(P<0.01),기혈청백단백수평[(34.2±1.2)g/L]고우대조조[(29.9±1.6)g/L](P<0.05);뇌척액검사현시,저사환자백세포수현저승고[(326±104)/μl여(5±3)/μl,P<0.01],당함량현저강저[(1.38±0.27)mmol/L여(3.47±0.29)mmol]L,P<0.01],단백수평[(1246±155)mg/L]역교대조조[여(669±206)mg/L]증고(P<0.05).결론 SLE환자발생CNS감염후예후불가.장기사용대제량격소화면역억제제자여출현불능해석적두통、발열증상차랑창정체활동성불고시,응급시행뇌척액검사배제차병.
Objective To identify the clinical differences between central nervous system (CNS) infection and neuropsychiatric lupus in patients with systemic lupus erythematosus (SLE). Method Clinical manifestations, lab test results and prognosis of 12 SLE patients complicated with CNS infections, hospitalized in Nanjing Drum Tower Hospital in the past four years, were reviewed and compared with those of 15 concomi-tantly treated patients with central neuropsychiatric lupus (NPL). Two-indenpendent samples t test, Mann-whitney test and Fisher exact test were used for statistical analysis. Results 83% of SLE patients with CNS infections were female and the average disease onset age was (37±4) years. As compared to neuro-psychiatric lupus patients (the control group), those patients with CNS infections (infection group) had lower lupus disease activity (SLEDAI score 14.3±1.6 vs 6.4±1.2, P<0.01) and took higher dose of corticosteroids [average prednisone dose (28.3±2.5) vs (8.4±3.0) mg/d, P<0.01 ] and more immunosuppressives agents (83% vs 33%, P<0.05) before the occurrence of CNS symptoms. Headache and fever were more common in the infection group (100% vs 46.7% and 91.7% vs 20%, both P<0.01) and simultaneously higher serum albumin levels [(34.2±1.2) g/L vs (29.9±1.6) g/L] were detected in those patients compared to the NPL patients (P<0.05). Cerebrospinal fluid examination showed that agents for a long time but without strong evidence of lupus disease activity, CNS infection should be considered at the appearance of headache and fever, and timely cerebrospinal fluid examination is required for the diagnosis.
