系统性红斑狼疮患者血脑屏障通透性的改变。
Alterations in Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus.
机构信息
From the Department of Radiology (J.M.C., K.C.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
Feinstein Institute for Medical Research (M.M., C.A., B.D.), The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
出版信息
AJNR Am J Neuroradiol. 2019 Mar;40(3):470-477. doi: 10.3174/ajnr.A5990. Epub 2019 Feb 21.
BACKGROUND AND PURPOSE
Neuropsychiatric systemic lupus erythematosus refers to central and peripheral nervous system involvement, which may occur secondary to antineuronal antibodies crossing the blood-brain barrier that preferentially target cells in the hippocampus leading to abnormal hypermetabolism and atrophy. Thus, we hypothesized that alterations in BBB permeability, detected on dynamic contrast-enhanced MR imaging, occur in the hippocampus in patients with systemic lupus erythematosus before development of neuropsychiatric systemic lupus erythematosus.
MATERIALS AND METHODS
Six patients with systemic lupus erythematosus without neuropsychiatric systemic lupus erythematosus and 5 healthy controls underwent dynamic contrast-enhanced MR imaging with postprocessing into BBB permeability parameters ( and Ve) and CBF. Standardized methods selected ROI sampling of the abnormal brain regions detected on FDG-PET. The mean and SD of , Ve, and CBF were calculated. Linear regression and nonparametric Spearman rank correlation analyses of and Ve with CBF were performed. Dynamic contrast-enhanced curves and the area under the curve were generated for each brain region. Student test comparisons were performed.
RESULTS
Quantitative data revealed that patients with systemic lupus erythematosus have statistically increased ( < .001) and Ve ( < .001) compared with controls. In patients with systemic lupus erythematosus, statistically significant positive correlations were seen between ( < .001) and Ve ( < .001) with CBF. Furthermore, the mean area under the curve revealed statistically increased BBB permeability in the hippocampus ( = .02) compared with other brain regions in patients with systemic lupus erythematosus compared with controls.
CONCLUSIONS
These initial findings are proof-of-concept to support the hypothesis that patients with systemic lupus erythematosus have increased BBB permeability, specifically in the hippocampus, compared with other brain regions. These findings may advance our understanding of the underlying pathophysiology affecting the brain in autoimmune diseases.
背景与目的
神经精神性狼疮是指中枢和外周神经系统受累，可能是由于抗神经元抗体穿过血脑屏障，优先靶向海马细胞，导致异常高代谢和萎缩所致。因此，我们假设在出现神经精神性狼疮之前，系统性红斑狼疮患者的海马体中存在血脑屏障通透性改变，这种改变可在动态对比增强磁共振成像上检测到。
材料与方法
对 6 例无神经精神性狼疮的系统性红斑狼疮患者和 5 例健康对照者进行了动态对比增强磁共振成像检查，并对血脑屏障通透性参数（ 和 Ve）和 CBF 进行了后处理。采用标准化方法对 FDG-PET 上检测到的异常脑区进行 ROI 采样。计算 、Ve 和 CBF 的平均值和标准差。对 和 Ve 与 CBF 进行了线性回归和非参数 Spearman 秩相关分析。为每个脑区生成了动态对比增强曲线和曲线下面积。进行了 Student t 检验比较。
结果
定量数据显示，与对照组相比，系统性红斑狼疮患者的 （ <.001）和 Ve（ <.001）明显升高。系统性红斑狼疮患者中， （ <.001）和 Ve（ <.001）与 CBF 之间存在显著正相关。此外，与对照组相比，系统性红斑狼疮患者的海马体（ =.02）平均曲线下面积显示出血脑屏障通透性增加。
结论
这些初步发现为系统性红斑狼疮患者的血脑屏障通透性增加，特别是在海马体，而不是其他脑区，提供了支持假说的证据。这些发现可能有助于深入了解影响自身免疫性疾病大脑的潜在病理生理学。
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