Roldan Carlos A, Gelgand Erika A, Qualls Clifford R, Sibbitt Wilmer L
Veterans Affairs Medical Center and University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87108, USA.
J Clin Rheumatol. 2006 Feb;12(1):3-10. doi: 10.1097/01.rhu.0000200378.42836.7f.
Central nonfocal neuropsychiatric systemic lupus erythematosus (NPSLE) manifests as cognitive dysfunction, acute confusional state, seizures, and psychosis. Valvular heart disease (VHD) is currently not a causal consideration of nonfocal NPSLE.
The objective of this study was to determine whether VHD is associated with nonfocal NPSLE.
Twenty-eight patients with SLE underwent: 1) clinical and laboratory evaluations; 2) neuropsychiatric evaluation; 3) brain magnetic resonance imaging (MRI); and 4) transesophageal echocardiography (TEE). Their findings were compared with those of 28 age- and-sex matched healthy volunteers.
Eighteen patients (64%) had nonfocal NPSLE. Cerebral infarcts on MRI were more common in patients with than without NPSLE (50% vs 10%, P=0.048) and antiphospholipid antibodies (aPL) were associated with old cerebral infarcts (P=0.03). Valvular heart disease was detected in 20 patients (71%) of whom 20 (71%) had valve thickening, 17 (61%) had valve regurgitation, and 15 (53%) had valve vegetations (12 on the mitral valve). Mitral valve vegetations were more common in patients with than without nonfocal NPSLE and in those with old cerebral infarcts (61% vs 10% and 75% vs 30%, respectively, P<or=0.02 for both). The nonneurologic activity of SLE and mitral valve vegetations were the only independent predictors of NPSLE (odds ratio [OR], 1.27 per unit value; confidence interval [CI], 1.1-1.6; P=0.03; and OR, 16.5; CI, 1.26-217; P=0.03, respectively). Among controls, none had neuropsychiatric syndromes, 4 (15%) had MRI abnormalities, and 3 (11%) had VHD (all P<or=0.001 vs patients).
Nonfocal NPSLE, cerebral infarcts, and VHD were highly associated and mitral valve vegetations were independent predictors of NPSLE. Thus, VHD exacerbated by hypercoagulability may cause thromboembolic ischemic brain injury and nonfocal NPSLE.
中枢非局灶性神经精神性系统性红斑狼疮（NPSLE）表现为认知功能障碍、急性意识模糊状态、癫痫发作和精神病。目前，瓣膜性心脏病（VHD）并非非局灶性NPSLE的病因考虑因素。
本研究旨在确定VHD是否与非局灶性NPSLE相关。
28例系统性红斑狼疮患者接受了：1）临床和实验室评估；2）神经精神评估；3）脑磁共振成像（MRI）；4）经食管超声心动图（TEE）检查。将他们的检查结果与28名年龄和性别匹配的健康志愿者的结果进行比较。
18例患者（64%）患有非局灶性NPSLE。MRI上的脑梗死在患有NPSLE的患者中比未患NPSLE的患者更常见（50%对10%，P=0.048），抗磷脂抗体（aPL）与陈旧性脑梗死相关（P=0.03）。20例患者（71%）检测到瓣膜性心脏病，其中20例（71%）有瓣膜增厚，17例（61%）有瓣膜反流，15例（53%）有瓣膜赘生物（12例在二尖瓣上）。二尖瓣赘生物在患有非局灶性NPSLE的患者中比未患非局灶性NPSLE的患者更常见，在患有陈旧性脑梗死的患者中也更常见（分别为61%对10%和75%对30%，两者P≤0.02）。SLE的非神经学活动和二尖瓣赘生物是NPSLE的仅有的独立预测因素（比值比[OR]，每单位值为1.27；置信区间[CI]，1.1 - 1.6；P=0.03；以及OR，16.5；CI，1.26 - 217；P=0.03）。在对照组中，无人患有神经精神综合征，4例（15%）有MRI异常，3例（11%）有VHD（与患者相比，所有P≤0.001）。
非局灶性NPSLE、脑梗死和VHD高度相关，二尖瓣赘生物是NPSLE的独立预测因素。因此，高凝状态加重的VHD可能导致血栓栓塞性缺血性脑损伤和非局灶性NPSLE。
