Karassa F B, Ioannidis J P, Boki K A, Touloumi G, Argyropoulou M I, Strigaris K A, Moutsopoulos H M
Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
Am J Med. 2000 Dec 1;109(8):628-34. doi: 10.1016/s0002-9343(00)00603-3.
We sought to identify the predictors of clinical outcome and of the evolution of cerebral abnormalities in patients with neuropsychiatric systemic lupus erythematosus (SLE).
Thirty-two patients with SLE (including 14 with the antiphospholipid syndrome) who had been hospitalized with primary neuropsychiatric disease were observed prospectively for at least 2 years. Laboratory and clinical characteristics and data from magnetic resonance imaging (MRI) studies obtained during the hospitalization and 2 years later were evaluated. We ascertained nonreversible or new MRI changes and clinical outcomes, including neuropsychiatric events, during follow-up.
Cranial MRI scans on admission were abnormal in 26 (81%) of the 32 patients. Patients with the antiphospholipid syndrome were more likely to have focal cerebral white matter lesions (odds ratio [OR] = 12, 95% confidence interval [CI]: 2.0 to 72). After 2 years, neuropsychiatric deficits substantially improved in 22 (69%) of the patients, stabilized in 6 (19%), and deteriorated in 4 (12%). The number of prior neuropsychiatric events was associated with persistent MRI lesions (OR = 4.8 per each event, 95% CI: 1.1 to 21) and unfavorable clinical outcome (OR = 4.3 per each event, 95% CI: 1.4 to 13) at 2 years. The antiphospholipid syndrome also predicted an unfavorable clinical outcome at 2 years (OR = 11, 95% CI: 1.7 to 65).
Among patients with SLE who have neuropsychiatric disease, prior neuropsychiatric events and the antiphospholipid syndrome increase the risk of adverse outcomes.
我们试图确定神经精神性系统性红斑狼疮（SLE）患者临床结局及脑异常演变的预测因素。
前瞻性观察32例因原发性神经精神疾病住院的SLE患者（包括14例抗磷脂综合征患者）至少2年。评估住院期间及2年后的实验室和临床特征以及磁共振成像（MRI）研究数据。我们确定了随访期间不可逆或新的MRI变化及临床结局，包括神经精神事件。
32例患者中26例（81%）入院时头颅MRI扫描异常。抗磷脂综合征患者更易出现局灶性脑白质病变（优势比[OR]=12，95%置信区间[CI]：2.0至72）。2年后，22例（69%）患者的神经精神缺陷显著改善，6例（19%）稳定，4例（12%）恶化。既往神经精神事件的数量与2年时持续的MRI病变（每次事件OR=4.8，95%CI：1.1至21）及不良临床结局（每次事件OR=4.3，95%CI：1.4至13）相关。抗磷脂综合征也预示2年时临床结局不良（OR=11，95%CI：1.7至65）。
在患有神经精神疾病的SLE患者中，既往神经精神事件和抗磷脂综合征会增加不良结局的风险。
