Tomietto P, Annese V, D'agostini S, Venturini P, La Torre G, De Vita S, Ferraccioli G F
University of Udine, Udine, Italy.
Arthritis Rheum. 2007 Dec 15;57(8):1461-72. doi: 10.1002/art.23098.
To determine factors affecting the severity of cognitive impairment in systemic lupus erythematosus (SLE) and to analyze its anatomic location.
Fifteen cognitive functions grouped into 8 domains were evaluated in 52 patients with SLE and 20 with rheumatoid arthritis. Patients were classified according to severity of impairment as normal, mild, or moderate/severe. Multivariate analysis was performed to identify the main factors affecting severity of cognitive deficits. The most likely anatomic site of damage according to neuropsychological performance was compared with the lesion's location on magnetic resonance imaging (MRI).
In SLE patients, a stepwise regression analysis showed that the number of impaired functions (dependent variable) was associated with antiphospholipid antibody positivity (aPL+; P = 0.04), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI; P = 0.001), hypertension (P = 0.032), and was inversely related to educational level (P = 0.021). Including MRI, the number of impaired functions was associated with severity of MRI (P < 0.001), the SDI (P = 0.013), and the presence of Raynaud's phenomenon (P = 0.04). The contemporary presence of aPL+ and Raynaud's phenomenon resulted in a higher probability to develop moderate/severe cognitive deficits (P = 0.015). Two logistic multiple regression analyses identified hypertension (P < 0.05), the SDI (P < 0.01), and moderate/severe MRI findings as main predictors of moderate/severe impairment (dependent variable). The damage site hypothesized through neuropsychological testing corresponded with MRI findings in 71.7% of SLE patients K = 0.42, P = 0.005).
Hypertension, aPL+, accumulated damage, and MRI lesions are the main factors affecting severity of cognitive impairment in SLE. The hypothesized sites of central nervous system involvement according to neuropsychological testing correlated with MRI findings in most patients.
确定影响系统性红斑狼疮（SLE）认知障碍严重程度的因素，并分析其解剖位置。
对52例SLE患者和20例类风湿关节炎患者评估了分为8个领域的15项认知功能。根据损伤严重程度将患者分为正常、轻度或中度/重度。进行多变量分析以确定影响认知缺陷严重程度的主要因素。根据神经心理学表现，将最可能的损伤解剖部位与磁共振成像（MRI）上的病变位置进行比较。
在SLE患者中，逐步回归分析显示，受损功能的数量（因变量）与抗磷脂抗体阳性（aPL+；P = 0.04）、系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SDI；P = 0.001）、高血压（P = 0.032）相关，且与教育水平呈负相关（P = 0.021）。纳入MRI后，受损功能的数量与MRI严重程度（P < 0.001）、SDI（P = 0.013）以及雷诺现象的存在（P = 0.04）相关。aPL+和雷诺现象同时存在会导致发生中度/重度认知缺陷的可能性更高（P = 0.015）。两项逻辑多元回归分析确定高血压（P < 0.05）、SDI（P < 0.01）和中度/重度MRI表现为中度/重度损伤（因变量）的主要预测因素。通过神经心理学测试假设的损伤部位与71.7%的SLE患者的MRI结果相符（K = 0.42，P = 0.005）。
高血压、aPL+、累积损伤和MRI病变是影响SLE认知障碍严重程度的主要因素。根据神经心理学测试假设的中枢神经系统受累部位在大多数患者中与MRI结果相关。
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