系统性红斑狼疮认知功能障碍的临床关联。
Clinical associations of cognitive dysfunction in systemic lupus erythematosus.
机构信息
Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
Rheumatology Department, Monash Health, Melbourne, Victoria, Australia.
出版信息
Lupus Sci Med. 2023 Feb;10(1). doi: 10.1136/lupus-2022-000835.
OBJECTIVE
Cognitive dysfunction in SLE is common, but clinical risk factors are poorly understood. This study aims to explore the associations of cognitive dysfunction in SLE with disease activity, organ damage, biomarkers and medications.
METHODS
We performed cross-sectional cognitive assessment using a conventional neuropsychological test battery, with normative values derived from demographically matched healthy subjects. Endpoints included two binary definitions of cognitive dysfunction and seven individual cognitive domain scores. Clinical parameters included disease activity (SLEDAI-2K) and organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). We performed regression analyses to determine associations between clinical parameters and cognitive endpoints.
RESULTS
89 patients with SLE were studied, with median age of 45 and disease duration of 15 years. Organ damage was significantly associated with severe cognitive dysfunction (OR 1.49, CI 1.01-2.22) and worse cognitive test performance in three of the seven individual cognitive domains. In contrast, no significant associations were found between SLEDAI-2K at the time of cognitive assessment and any cognitive endpoints on multivariate analysis. Higher time-adjusted mean SLEDAI-2K was associated with better verbal memory scores but had no significant associations with other cognitive endpoints. The presence of anti-dsDNA antibodies and high IFN gene signature were negatively associated with severe cognitive dysfunction; there were no significant associations with the other autoantibodies studied or any medications. Substance use was significantly associated with lower psychomotor speed. Only 8% of patients who had cognitive dysfunction on testing had been recognised by clinicians on their SDI score.
CONCLUSIONS
In SLE, cognitive dysfunction was positively associated with organ damage, but not associated with disease activity, and serological activity and high IFN signature were negatively associated. Cognitive dysfunction was poorly captured by clinicians. These findings have implications for preventative strategies addressing cognitive dysfunction in SLE.
目的
SLE 患者常存在认知功能障碍，但临床相关危险因素尚未明确。本研究旨在探讨 SLE 患者认知功能障碍与疾病活动度、器官损伤、生物标志物和药物的相关性。
方法
我们使用常规神经心理学测试组合进行横断面认知评估，并采用与人口统计学匹配的健康受试者的正常值。终点包括两种认知功能障碍的二分法定义和七个单独认知域的评分。临床参数包括疾病活动度（SLEDAI-2K）和器官损伤（系统性红斑狼疮国际合作临床中心/美国风湿病学会损伤指数）。我们进行回归分析以确定临床参数与认知终点之间的相关性。
结果
共纳入 89 例 SLE 患者，中位年龄 45 岁，病程 15 年。器官损伤与严重认知功能障碍显著相关（OR 1.49，95%CI 1.01-2.22），且在七个单独认知域中的三个域认知测试表现更差。相比之下，在多变量分析中，认知评估时的 SLEDAI-2K 与任何认知终点均无显著相关性。更高的时间调整平均 SLEDAI-2K 与更好的言语记忆评分相关，但与其他认知终点无显著相关性。抗 dsDNA 抗体和高 IFN 基因特征与严重认知功能障碍呈负相关；与其他研究的自身抗体或任何药物均无显著相关性。物质使用与精神运动速度降低显著相关。在接受测试的认知功能障碍患者中，仅有 8%的患者在他们的 SDI 评分中被临床医生识别出来。
结论
在 SLE 中，认知功能障碍与器官损伤呈正相关，与疾病活动度无关，而血清学活动和高 IFN 特征与认知功能障碍呈负相关。临床医生对认知功能障碍的识别较差。这些发现对 SLE 认知功能障碍的预防策略具有重要意义。
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