Mukai M, Sagawa A, Baba Y, Amasaki Y, Katsumata K, Yoshikawa M, Nakabayashi T, Watanabe I, Yasuda I, Fujisaku A
Second Department of Internal Medicine, Hokkaido University, School of Medicine, Sapporo-city.
Ryumachi. 1990 Apr;30(2):109-18.
Neuro-psychiatric complications of primary Sjögren's syndrome (SjS) were studied on their frequency and characteristics of clinical signs in 150 patients of our clinic. Clinical symptoms and laboratory examinations were compared in the patients group complicated with neuro-psychiatric symptoms and the non-complicated group. Neuro-psychiatric symptoms (neuro SjS) were complicated with 63 patients (42.0%). Central nervous system (CNS) involvement were occurred in 47 patients (31.3%). In this group (CNS SjS), psychiatric complications were observed in 43 patients (28.7%), consisted with 29 cases of neurosis, 7 cases of depression, 6 cases of presenile dementia, and others. Nine patients (6.0%) in this group had neurologic involvement that were 3 cases of aseptic meningitis, 3 cases of neurogenic bladder, and each case of multiple infarction, multiple sclerosis, and others. These 9 patients showed more frequently positive results for rheumatoid factor, anti-SSA antibody, leucopenia, and lymphopenia, so this subgroup might be consisted of a small group which was resemble to systemic lupus erythematosus. Cranial nerve involvement, mainly injured in trigeminal nerve, and peripheral nerve involvement were complicated with 5 patients (3.3%) and 24 patients (16.0%), respectively. In neuro-psychiatric complicated group, mean age was older and dry mouth were more frequent (p less than 0.05) than non-complicated group. In psychiatric complicated group, mean age was older (p less than 0.01) and dry mouth were more frequent (p less than 0.05). In any groups of neuro-psychiatric complications, the frequency of any autoantibodies was not statistically different from non-complicated group. But, in the group of cranial nerve involvement, anti-RNP antibody was 60.0% positive (in non-complicated group, 17.2%: p less than 0.05). In CNS SjS group, magnetic resonance imaging (MRI) abnormalities were occurred in 8 of 13 patients. High intensity lesions in white matter on the T2-weighted examinations was characteristic, which showed lacnar infarctions or demyelinated lesions in MRI abnormalities. In CNS SjS, corticosteroid or immunosuppressant was not always necessary, because this complication was self-limited or enough controlled by minor-tranquilizer or anti-depressant. The character of onset in neuro SjS was chronic and neuro SjS was insidiously developing disease. And more studies including treatment on neuro SjS were needed.
我们诊所对150例原发性干燥综合征（SjS）患者的神经精神并发症的发生频率及临床体征特征进行了研究。对合并神经精神症状的患者组和未合并的患者组的临床症状及实验室检查结果进行了比较。63例患者（42.0%）合并神经精神症状（神经型SjS）。47例患者（31.3%）出现中枢神经系统（CNS）受累。在该组（中枢神经系统型SjS）中，43例患者（28.7%）出现精神并发症，包括29例神经症、7例抑郁症、6例早老性痴呆等。该组9例患者（6.0%）出现神经受累，其中3例为无菌性脑膜炎、3例为神经源性膀胱，以及各1例多发性梗死、多发性硬化等。这9例患者类风湿因子、抗SSA抗体、白细胞减少和淋巴细胞减少的阳性结果更为常见，因此该亚组可能由一小部分类似于系统性红斑狼疮的患者组成。5例患者（3.3%）合并颅神经受累，主要累及三叉神经，24例患者（16.0%）合并周围神经受累。在合并神经精神并发症的患者组中，平均年龄较大，口干更为常见（p<0.05），高于未合并组。在合并精神并发症的患者组中，平均年龄较大（p<0.01），口干更为常见（p<0.05）。在任何神经精神并发症组中，任何自身抗体的频率与未合并组相比均无统计学差异。但是，在颅神经受累组中，抗RNP抗体阳性率为60.0%（未合并组为17.2%：p<0.05）。在中枢神经系统型SjS组中，13例患者中有8例出现磁共振成像（MRI）异常。T2加权检查中白质的高强度病变具有特征性，在MRI异常中表现为腔隙性梗死或脱髓鞘病变。在中枢神经系统型SjS中，不一定需要使用皮质类固醇或免疫抑制剂，因为这种并发症具有自限性，或通过小剂量镇静剂或抗抑郁药即可充分控制。神经型SjS的起病特点为慢性，是一种隐匿性发展的疾病。并且需要更多包括对神经型SjS治疗的研究。
