Toubi E, Khamashta M A, Panarra A, Hughes G R
Lupus Arthritis Research Unit, Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
Am J Med. 1995 Oct;99(4):397-401. doi: 10.1016/s0002-9343(99)80188-0.
To determine the prevalence and characteristics of central nervous system disease in systemic lupus erythematosus (CNS/SLE) with particular reference to disease activity and to the presence of antiphospholipid (aPL) antibodies.
From 340 unselected SLE patients attending our lupus clinic, we found 96 (28%) to have definite CNS manifestations not attributed to any cause other than SLE. Patients with mild migraine or cognitive disorders were excluded. The control group consisted of 100 SLE patients without CNS or thromboembolic manifestations.
Fifty-six of our CNS patients had transient ischemic attacks or strokes, 24 had epilepsy, and 12 had psychiatric disorders; the other 4 did not fulfill SLE criteria. In all, 55% of patients (53) were found to be positive for aPL antibodies, whereas only 20% of the SLE control group were positive (P < 0.001). Based on a physicians' global clinical assessment tool together with laboratory analysis, only 42 (44%) patients were found to be active at the onset of CNS manifestations, and the other 54 (56%) were nonactive. A finding of aPL antibodies was associated strongly with the inactive CNS/SLE group (P = 0.001). Of the 53 patients who underwent magnetic resonance imaging (MRI) study, 33 showed small high-density lesions suggestive of vasculopathy. Twenty-six (79%) of them were positive for aPL antibodies; whereas of the 20 patients with normal MRIs, only 8 (40%) were positive for aPL antibodies (P < 0.01).
We confirm that CNS disease in SLE is significantly associated with the presence of aPL antibodies. The CNS manifestations can occur in about half of SLE patients without any other evidence of lupus activity. Abnormal MRIs highly correlate with positive aPL antibodies.
确定系统性红斑狼疮（CNS/SLE）中枢神经系统疾病的患病率及特征，尤其涉及疾病活动度和抗磷脂（aPL）抗体的存在情况。
在我们狼疮门诊的340例未经挑选的SLE患者中，我们发现96例（28%）有明确的中枢神经系统表现，且这些表现并非由SLE以外的任何原因引起。轻度偏头痛或认知障碍患者被排除。对照组由100例无中枢神经系统或血栓栓塞表现的SLE患者组成。
我们的中枢神经系统疾病患者中有56例发生短暂性脑缺血发作或中风，24例有癫痫，12例有精神障碍；另外4例不符合SLE标准。总体而言，55%的患者（53例）aPL抗体呈阳性，而SLE对照组中只有20%呈阳性（P<0.001）。根据医生的整体临床评估工具及实验室分析，仅42例（44%）患者在中枢神经系统表现出现时处于活动期，另外54例（56%）为非活动期。aPL抗体的检测结果与非活动期CNS/SLE组密切相关（P = 0.001）。在接受磁共振成像（MRI）检查的53例患者中，33例显示出提示血管病变的小高密度病灶。其中26例（79%）aPL抗体呈阳性；而在MRI正常的20例患者中，只有8例（40%）aPL抗体呈阳性（P<0.01）。
我们证实SLE中枢神经系统疾病与aPL抗体的存在显著相关。中枢神经系统表现可出现在约一半的SLE患者中，且无任何其他狼疮活动的证据。MRI异常与aPL抗体阳性高度相关。
