Bai Ru, Yang Yifan, Liu Shuang, Li Shu, Zhao Ruotong, Wang Xiangyu, Cheng Yuqi, 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; Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Semin Arthritis Rheum. 2025 Apr;71:152620. doi: 10.1016/j.semarthrit.2024.152620. Epub 2024 Dec 22.
The study aimed to investigate the damage of white matter (WM) microstructure and structural network in patients with systemic lupus erythematosus (SLE) using diffusion tensor imaging.
Tract-based spatial statistics (TBSS) were used to compare the difference in WM fractional anisotropy (FA) between SLE and HCs groups. The differences in WM networks between groups are compared using graph theory. The correlation between clinical data and SLE abnormal WM structure and network was analysed.
The sample included 140 SLE patients and 111 healthy controls (HCs). Due to data missing, excessive head movement amplitude, failure of quality control and other reasons, 127 cases of SLE (103 females, mean age 29.84 years (SD 7.00), median years of education 12.00, interquartile range(9.00,15.00) and a median course of disease (month) 12.00, interquartile range (3.00,24.00)) and 102 cases of HCs (76 females, mean age 30.63 years (SD 7.24), median years of education 15.00, interquartile range(12.00,16.00)) were finally included in the study. The FA values of 5 clusters involving the right retrolenticular part of the internal capsule (RLIC), the genu of corpus callosum (GCC), the body of corpus callosum, the splenium of corpus callosum (SCC), were significantly lower in the SLE group compared to the HCs (P < 0.05 with threshold-free cluster enhancement corrected). The SLEDAI showed a negative correlation with FA in GCC, and HAMD showed a negative correlation with FA in SCC and right RLIC (P < 0.05). Regarding network indicators, Cp, E, and E were significantly decreased, while Lp was significantly increased in the SLE group. The degree centrality (DC) of 6 brain regions and the E of 17 regions were significantly lower in the SLE group. SLEDAI showed a negative correlation with the area under the curve (AUC) of DC and E in the left inferior frontal gyrus triangular (q < 0.05 with false discovery rate corrected), while MMSE showed a positive correlation with the E in the left hippocampus (P < 0.05).
The study concludes that changes in WM microstructure and its structural network may contribute to the development of severe neuropsychiatric symptoms in SLE patients. These changes may be the basis of brain damage that leads to the development of NPSLE from SLE without major neuropsychiatric manifestations.
本研究旨在利用扩散张量成像技术调查系统性红斑狼疮（SLE）患者白质（WM）微观结构和结构网络的损伤情况。
采用基于纤维束的空间统计学（TBSS）比较SLE组和健康对照（HCs）组之间WM分数各向异性（FA）的差异。使用图论比较两组之间WM网络的差异。分析临床数据与SLE异常WM结构和网络之间的相关性。
样本包括140例SLE患者和111例健康对照。由于数据缺失、头部运动幅度过大、质量控制失败等原因，最终纳入研究的SLE患者有127例（女性103例，平均年龄29.84岁（标准差7.00），教育年限中位数12.00，四分位间距（9.00,15.00），疾病病程中位数（月）12.00，四分位间距（3.00,24.00）），HCs有102例（女性76例，平均年龄30.63岁（标准差7.24），教育年限中位数15.00，四分位间距（12.00,16.00））。与HCs组相比，SLE组中涉及右侧内囊后肢（RLIC）、胼胝体膝部（GCC）、胼胝体体部、胼胝体压部（SCC）的5个簇的FA值显著降低（经无阈值簇增强校正后P<0.05）。SLE疾病活动指数（SLEDAI）与GCC中的FA呈负相关，汉密尔顿抑郁量表（HAMD）与SCC和右侧RLIC中的FA呈负相关（P<0.05）。关于网络指标，SLE组的聚类系数（Cp）、边数（E）和全局效率（E）显著降低，而局部效率（Lp）显著增加。SLE组6个脑区的度中心性（DC）和17个区域的E显著降低。SLEDAI与左侧额下回三角区DC和E的曲线下面积（AUC）呈负相关（经错误发现率校正后q<0.05），而简易精神状态检查表（MMSE）与左侧海马体的E呈正相关（P<0.05）。
本研究得出结论，WM微观结构及其结构网络的变化可能导致SLE患者出现严重的神经精神症状。这些变化可能是导致无主要神经精神表现的SLE发展为神经精神性SLE的脑损伤基础。
