Bresnihan B, Hohmeister R, Cutting J, Travers R L, Waldburger M, Black C, Jones T, Hughes G R
Ann Rheum Dis. 1979 Aug;38(4):301-6. doi: 10.1136/ard.38.4.301.
As part of a prospective survey of systemic lupus erythematosus (SLE) a detailed collaborative study of the clinical, psychiatric, and laboratory features in 15 patients with nonfocal neuropsychiatric disease has been undertaken. In addition to conventional clinical and psychometric evaluation, electroencephalograph, and cerebrospinal fluid analysis, the study included the assessment of cerebral blood flow with oxygen-15 brain scans and serological testing for the presence of antineuronal and lymphocytotoxic antibodies. Of the 15 patients 12 had psychiatric manifestations, while 13 had various neurological abnormalities. All except 2 episodes of cerebral disease were transient. Striking abnormalities in cerebral blood flow and metabolism were seen in 12 patients, even in the presence of subtle clinical features. Sequential scans showed that improvement in clinical features was accompanied by a reversal of scan abnormalities. All sera contained brain-reactive antibody, either antineuronal IgG antibody (13) or lymphocytotoxic IgM antibody (12) or both (10), though there was an inconsistent association between clinical features and antibody titre. It is suggested that transient disturbances of cerebral vascular function in SLE might allow brain-reactive antibodies from the circulation access to cerebral tissue. In this way the nature of the neuropsychiatric abnormalities would depend on both vascular and immunopathogenic mechanisms.
作为系统性红斑狼疮（SLE）前瞻性调查的一部分，对15例非局灶性神经精神疾病患者的临床、精神和实验室特征进行了详细的协作研究。除了常规的临床和心理测量评估、脑电图和脑脊液分析外，该研究还包括用氧-15脑扫描评估脑血流量以及检测抗神经元和淋巴细胞毒性抗体的血清学检测。15例患者中，12例有精神症状，13例有各种神经异常。除2次脑部疾病发作外，所有症状均为短暂性。12例患者出现了明显的脑血流量和代谢异常，即使存在细微的临床特征。连续扫描显示，临床特征的改善伴随着扫描异常的逆转。所有血清均含有脑反应性抗体，要么是抗神经元IgG抗体（13例），要么是淋巴细胞毒性IgM抗体（12例），要么两者都有（10例），尽管临床特征与抗体滴度之间的关联并不一致。提示SLE中脑血管功能的短暂紊乱可能使循环中的脑反应性抗体进入脑组织。通过这种方式，神经精神异常的性质将取决于血管和免疫致病机制。
