Olsen M L, O'Connor S, Arnett F C, Rosenbaum D, Grotta J C, Warner N B
Department of Internal Medicine, University of Texas Health Science Center, Houston 77225.
Am J Med. 1991 Apr;90(4):479-88.
To determine the prevalence and spectrum of underlying rheumatic diseases, especially Sjögren's syndrome (SS) and the antiphospholipid syndrome, and the prevalence of the lupus anticoagulant, antinuclear antibody (ANA), and rheumatoid factor (RF) within a neurologic patient population.
The study design entailed a prospective, consecutive sample of patients admitted to a university-affiliated neurology service for 72 hours or more. Study patients were obtained from a sequential evaluation of 100 inpatients with a wide spectrum of neurologic diseases. Another 31 eligible patients were not included due to refusal (n = 4), inability to give consent (n = 12), or an incomplete database (n = 15). All patients underwent a physical examination and responded to a rheumatic disease questionnaire (administered by one rheumatologist) assessing signs and symptoms relevant to rheumatic disease. All had lupus anticoagulant, ANA, and RF determinations. An independent patient evaluation was done by the attending neurologist.
Eleven patients had a rheumatic or autoimmune disorder directly related to their neurologic admission: three patients with SS (one each with embolic stroke, dementia, and hemiparetic somatization); three patients with lupus anticoagulant syndrome (all with stroke, recurrent in two); one patient with systemic lupus erythematosus accompanied by migraine headache and the lupus anticoagulant; and one patient each with isolated central nervous system (CNS) angiitis, neuro-Behçet's disease, CNS Whipple's disease, and HLA-B27-associated spondyloarthropathy. Nineteen patients had one or more autoantibodies: ANA greater than or equal to 1:80 (n = 10); RF greater than or equal to 1:80 (n = 6); and positive lupus anticoagulant (n = 7). The seroreactivity of 10 of these patients remained unexplained.
This neurologic population demonstrated significant seroreactivity and rheumatic disease associations, with SS and lupus anticoagulant-related neurologic disease the most common. Since SS and the antiphospholipid syndrome can be overlooked, it is recommended that a formal evaluation for SS and a direct lupus anticoagulant assay should be considered in the examination of patients with neuropsychiatric symptoms.
确定潜在风湿性疾病的患病率及谱系，尤其是干燥综合征（SS）和抗磷脂综合征，以及狼疮抗凝物、抗核抗体（ANA）和类风湿因子（RF）在神经系统疾病患者群体中的患病率。
本研究设计为对一所大学附属医院神经科收治72小时及以上的患者进行前瞻性连续抽样。研究患者来自对100例患有广泛神经系统疾病的住院患者的序贯评估。另外31例符合条件的患者因拒绝（n = 4）、无法给予同意（n = 12）或数据库不完整（n = 15）而未纳入。所有患者均接受体格检查，并对一份由一名风湿病学家管理的风湿性疾病问卷做出回应，该问卷评估与风湿性疾病相关的体征和症状。所有患者均进行了狼疮抗凝物、ANA和RF检测。由主治神经科医生进行独立的患者评估。
11例患者患有与其神经系统入院直接相关的风湿性或自身免疫性疾病：3例SS患者（分别为栓塞性中风、痴呆和偏瘫性躯体化各1例）；3例狼疮抗凝物综合征患者（均有中风，2例复发）；1例系统性红斑狼疮患者伴有偏头痛和狼疮抗凝物；以及1例分别患有孤立性中枢神经系统（CNS）血管炎、神经白塞病、CNS惠普尔病和HLA - B27相关脊柱关节病的患者。19例患者有一种或多种自身抗体：ANA大于或等于1:80（n = 10）；RF大于或等于1:80（n = 6）；狼疮抗凝物阳性（n = 7）。其中10例患者的血清反应性原因不明。
该神经系统疾病患者群体显示出显著的血清反应性和风湿性疾病关联，其中SS和狼疮抗凝物相关的神经系统疾病最为常见。由于SS和抗磷脂综合征可能被忽视，建议在对有神经精神症状的患者进行检查时考虑对SS进行正式评估和直接狼疮抗凝物检测。
