论文部分内容阅读
目的探讨神经精神性SLE(NPSLE)患者发病的危险因素、临床表现和治疗。方法回顾分析42例NPSLE患者(NPSLE组)的临床资料,并根据美国风湿病协会(ACR)制订的NPSLE命名和19种临床类型分型。设同期住院的187例无神经精神症状的SLE患者为对照组(非NPSLE组),比较两组患者的临床表现、实验室指标及狼疮疾病活动性指数(SLEDAI)。结果NPSLE组患者50%发作前有明确的诱因,42例患者共出现12种症状类型,73.8%患者有两种及其以上表现,以癫痫(27.0%)、脑血管病变(20.6%)和急性精神错乱(14.3%)最常见。NPSLE组发热、红细胞沉降率升高、血小板减少的发生率、SLEDAI分值以及死亡率分别高于非NPSLE组。差异有统计学意义(P<0.05)。盘状红斑、关节痛的发生率以及正规使用糖皮质激素或合用免疫抑制剂的患者比例分别低于非NPSLE组.差异有统计学意义(P<0.05)。NPSLE患者死亡原因有疾病本身、并发感染、重要脏器功能衰竭。结论NPSLE患者病情严重.疾病活动性高,预后差。正规治疗和预防并发症能避免诱发NPSLE,同时能改善其预后。
Objective To investigate the risk factors, clinical manifestation and treatment of patients with neuropsychiatric SLE (NPSLE). Methods The clinical data of 42 patients with NPSLE (NPSLE group) were retrospectively analyzed. According to the NPSLE nomenclature and 19 clinical types of the American Rheumatism Association (ACR). A total of 187 SLE patients with neuropsychiatric symptoms during the same period of hospitalization were enrolled as control group (non-NPSLE group). The clinical manifestations, laboratory parameters and lupus disease activity index (SLEDAI) were compared between the two groups. Results In the NPSLE group, there were definite inducement before 50% of attacks. Twelve symptom types were found in 42 patients. There were two or more symptoms in 73.8% of the patients, with epilepsy (27.0%), cerebrovascular disease (20.6%) and acute Insanity (14.3%) is the most common. NPSLE group fever, increased erythrocyte sedimentation rate, the incidence of thrombocytopenia, SLEDAI scores and mortality were higher than non-NPSLE group. The difference was statistically significant (P <0.05). The incidence of discoid erythema, arthralgia, and the proportion of patients receiving regular glucocorticoid or combined immunosuppressive agents were significantly lower than those of non-NPSLE patients (P <0.05). The causes of death in patients with NPSLE disease itself, complicated by infection, vital organ failure. Conclusion NPSLE patients are in serious condition with high disease activity and poor prognosis. Formal treatment and prevention of complications can prevent the induction of NPSLE, while improving its prognosis.