Liu Shuang, Cheng Yuqi, Zhao Yueyin, Yu Hongjun, Lai Aiyun, Lv Zhaoping, Xu Xiufeng, Luo Chunrong, Shan Baoci, Xu Lin, Xu Jian
Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.
Front Psychiatry. 2018 Feb 1;9:8. doi: 10.3389/fpsyt.2018.00008. eCollection 2018.
The aim of the study was to find structural brain changes in systemic lupus erythematosus patients without major neuropsychiatric manifestations [non-neuropsychiatric systemic lupus erythematosus (non-NPSLE)] using quantitative magnetic resonance imaging (MRI) and possible associations with clinical characteristics. 89 non-NPSLE patients with normal conventional MRI and 84 healthy controls (HCs) were recruited. The whole brain gray matter volume (GMV) and white matter volume (WMV) were calculated for each individual. We found obvious GMV and WMV reduction in the systemic lupus erythematosus (SLE) group compared with HCs. Female patients showed significant reduction of GMV and WMV compared with male patients. Patients treated with immunosuppressive agents (ISA) showed less WMV reduction than those without. Cognitive impairment was the most common subclinical neuropsychiatric manifestation and had a prevalence of 46.1%. Association between WMV reduction with cognitive impairment was found. Thus, we concluded that structural brain atrophy could happen even before occurrence of obvious neuropsychiatric signs and symptoms and was associated with subclinical symptoms such as cognitive impairment. ISA treatment might have a protective effect on the brain atrophy. Early treatment might prevent the progressive damage to the brain. More studies are needed to fully understand the complicated underlying mechanisms of brain atrophy in SLE.
本研究的目的是利用定量磁共振成像（MRI）找出无重大神经精神表现的系统性红斑狼疮患者[非神经精神性系统性红斑狼疮（non-NPSLE）]大脑的结构变化，以及这些变化与临床特征之间可能存在的关联。招募了89例常规MRI正常的non-NPSLE患者和84例健康对照者（HCs）。计算了每个个体的全脑灰质体积（GMV）和白质体积（WMV）。我们发现，与HCs相比，系统性红斑狼疮（SLE）组的GMV和WMV明显减少。女性患者的GMV和WMV比男性患者显著减少。接受免疫抑制剂（ISA）治疗的患者的WMV减少程度低于未接受治疗的患者。认知障碍是最常见的亚临床神经精神表现，患病率为46.1%。发现WMV减少与认知障碍之间存在关联。因此，我们得出结论，即使在明显的神经精神症状出现之前，大脑结构萎缩就可能发生，并且与认知障碍等亚临床症状有关。ISA治疗可能对脑萎缩有保护作用。早期治疗可能预防大脑的进行性损伤。需要更多研究来全面了解SLE脑萎缩复杂的潜在机制。
