Salomonsson Tim, Zervides Kristoffer A, Jönsen Andreas, Knutsson Malte, Wirestam Ronnie, Lätt Jimmy, Bengtsson Anders A, Knutsson Linda, Sundgren Pia C
Department of Clinical Sciences, Diagnostic Radiology, Lund University, Skåne University Hospital, 221 85, Lund, Sweden.
Department of Clinical Sciences, Rheumatology, Lund University, Skåne University Hospital, 222 42, Lund, Sweden.
Neuroimage Rep. 2024 Dec 31;5(1):100232. doi: 10.1016/j.ynirp.2024.100232. eCollection 2025 Mar.
High disease activity, cognitive dysfunction (CD), fatigue and pain negatively affect the quality of life in patients with systemic lupus erythematosus (SLE). However, the impact on brain perfusion and blood-brain barrier (BBB) permeability remains incompletely understood. Therefore, we utilized 3 T dynamic susceptibility contrast magnetic resonance imaging to investigate these factors in a cohort of 66 female SLE patients. Normalized leakage corrected cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and the BBB leakage parameter K were compared within the cohort by splitting the group into patients with and without each symptom respectively. Fourteen regions of interest were chosen, and the results were adjusted for age, disease duration, smoking and glucocorticoids. We found regional significant alterations in the different SLE subgroups compared to patients without each corresponding symptom, with patterns as follows: moderate to high disease activity (n = 17, decreased MTT, increased K), CD in ≥1 domain (n = 36, decreased MTT, increased K), CD in ≥2 domains (n = 20, increased CBF, CBV and K), fatigue (n = 44, increased CBV and MTT), pain (n = 9, increased CBF and CBV, decreased MTT). Additionally, inverse correlations were found between cognitive scores and K in multiple areas, indicating increased BBB permeability with worse cognitive performance. To elucidate the underlying mechanisms, longitudinal studies should be conducted in a larger variation of patients, using different measurements of BBB disruption.
高疾病活动度、认知功能障碍（CD）、疲劳和疼痛会对系统性红斑狼疮（SLE）患者的生活质量产生负面影响。然而，其对脑灌注和血脑屏障（BBB）通透性的影响仍未完全明确。因此，我们利用3T动态磁敏感对比磁共振成像技术，对66例女性SLE患者进行了相关因素研究。将患者按是否有每种症状分为两组，比较两组间标准化渗漏校正脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）以及BBB渗漏参数K。选取了14个感兴趣区域，并对结果进行年龄、病程、吸烟和糖皮质激素的校正。我们发现，与无相应症状的患者相比，不同SLE亚组存在区域显著改变，具体情况如下：中度至高度疾病活动度（n = 17，MTT降低，K升高）、≥1个领域存在CD（n = 36，MTT降低，K升高）、≥2个领域存在CD（n = 20，CBF、CBV和K升高）、疲劳（n = 44，CBV和MTT升高）、疼痛（n = 9，CBF和CBV升高，MTT降低）。此外，在多个区域发现认知评分与K呈负相关，提示BBB通透性增加与认知功能减退有关。为阐明潜在机制，应在更多样化的患者中进行纵向研究，采用不同的BBB破坏测量方法。
