CAJ | 학술논문

目的总结系统性红斑狼疮(SLE)合并中枢神经系统(CNS)结核瘤的临床特点,提高临床医师对此病的认识.方法回顾分析2009年至2011年北京协和医院收治的8例SLE合并CNS结核瘤患者临床资料,总结其临床特点、治疗和转归.结果 SLE合并CNS结核瘤的发生率约0.45％(8/1768).8例SLE患者出现CNS结核瘤的平均病程为(39 ±32)个月,泼尼松维持用量均＞15 mg/d.SLE患者诊断CNS结核瘤时7例(7/8)患者SLEDAI评分小于5分.CNS结核瘤的常见症状包括发热(7/8)、头痛(5/8)、运动或感觉障碍(5/8)等,1例出现一过性全身抽搐伴意识丧失.脑脊液检查主要表现为压力升高和蛋白水平升高(分别为5/8),仅1例患者白细胞数显著升高,多正常或轻度升高.CNS结核瘤在MRI增强扫描中特征性表现为异常类圆形信号并环形强化,可分布于颅内或者脊髓.8例患者均伴有其他部位结核,包括肺、消化道和皮肤.所有患者均予抗结核治疗,1例患者同时接受手术.随访7例患者平均(20±9)个月,仅3例遗留轻微症状,治疗均有效(7/7).结论 SLE合并CNS结核瘤常发生于长期激素治疗患者,多数SLE病情稳定,其临床表现和脑脊液改变不典型,伴发全身多部位结核感染灶可协助诊断,头颅或脊髓MRI增强扫描可见特征性类圆形信号并环形强化.SLE合并CNS结核瘤经早期积极诊治,预后良好.
목적 총결계통성홍반랑창(SLE)합병중추신경계통(CNS)결핵류적림상특점,제고림상의사대차병적인식.방법 회고분석2009년지2011년북경협화의원수치적8례SLE합병CNS결핵류환자림상자료,총결기림상특점、치료화전귀.결과 SLE합병CNS결핵류적발생솔약0.45％(8/1768).8례SLE환자출현CNS결핵류적평균병정위(39 ±32)개월,발니송유지용량균＞15 mg/d.SLE환자진단CNS결핵류시7례(7/8)환자SLEDAI평분소우5분.CNS결핵류적상견증상포괄발열(7/8)、두통(5/8)、운동혹감각장애(5/8)등,1례출현일과성전신추휵반의식상실.뇌척액검사주요표현위압력승고화단백수평승고(분별위5/8),부1례환자백세포수현저승고,다정상혹경도승고.CNS결핵류재MRI증강소묘중특정성표현위이상류원형신호병배형강화,가분포우로내혹자척수.8례환자균반유기타부위결핵,포괄폐、소화도화피부.소유환자균여항결핵치료,1례환자동시접수수술.수방7례환자평균(20±9)개월,부3례유류경미증상,치료균유효(7/7).결론 SLE합병CNS결핵류상발생우장기격소치료환자,다수SLE병정은정,기림상표현화뇌척액개변불전형,반발전신다부위결핵감염조가협조진단,두로혹척수MRI증강소묘가견특정성류원형신호병배형강화.SLE합병CNS결핵류경조기적겁진치,예후량호.
Objective To review the clinical features of systemic lupus erythematosus (SLE) patients with central nervous system (CNS) tuberculoma.Methods The medical records of 8 SLE patients with CNS tuberculoma,who were admitted to Peking Union Medical College Hospital from January 2009 to January 2012,were reviewed in this retrospective study.Results CNS tuberculoma occurred averagely 39 months after immunosuppressive therapy with an incidence of 0.45％ in SLE patients.These patients had an average SLEDAI score less than 5,and their minimal maintenance dose of prednisone was 15 mg/d.Fever (7/8),headache (5/8),motion and sensory disorder (5/8) were the most common symptoms of CNS tuberculoma in SLE patients,and one patient had temporary seizure with loss of consciousness.Cerebrospinal fluid pressure and protein level of these patients increased significantly,while white blood cells were mostly normal or mildly elevated.Gadolinium-enhanced MRI revealed specific ring-like masses in all cases.Other organs infected with tuberculosis occurred in all of them.They all received anti-tuberculosis drugs and one had additional cerebral operation.Seven patients were followed for (20 ± 9) months and all recovered.Conclusions CNS tuberculoma usually occurred in non-active SLE patients receiving long-term immunosuppressive therapy,with atypical clinical manifestations and cerebrospinal fluid changes.Enhanced MRI showed ring-like masses which were specific for diagnosis of CNS tuberculoma.Early diagnosis and effective anti-tuberculosis therapy contributes to a benign prognosis.