多学科协作对神经精神狼疮磁共振成像特点的分类

doi:10.19723/j.issn.1671-167X.2018.06.012

摘要/Abstract

摘要：

目的: 探讨神经精神狼疮(neuropsychiatric lupus,NPSLE)的头颅磁共振成像(magnetic resonance imaging,MRI)表现特点与临床的相关性。方法: 回顾性分析2006年1月—2016年10月北京大学第三医院收治的65例NPSLE患者头颅MRI表现和临床资料,由风湿免疫科、神经内科以及放射科医生对其头颅MRI表现进行综合分类,分析头颅MRI表现与临床表现的相关性。结果: 65例NPSLE患者头颅MRI表现特点被分为6类:脑白质脱髓鞘改变16例(25%)、血管病变15例(23%)[包括大血管病4例(6%)、小血管病11例(17%)]、炎症4例(6%)、水肿4例(6%)、多种病变共存13例(20%)、无异常13例(20%)。除4例头颅MRI表现为水肿患者的临床表现只有癫痫大发作外,其他患者临床表现复杂多样,包括癫痫大发作、狼疮样头痛、精神症状、视物模糊、周围神经病变和意识障碍。头颅MRI表现为水肿的患者癫痫大发作发生率显著高于其他5类MRI表现患者,且对于治疗反应时间最短,临床症状缓解最快。结论: 多学科协作将NPSLE患者头颅MRI表现分成6类,该分类方法有助于临床医生预估并在早期干预可能出现的神经精神症状,从而指导临床治疗。

关键词: 神经精神狼疮, 磁共振成像, 临床症状

Abstract:

Objective: To investigate the clinical correlation between the manifestations of neuropsychiatric lupus (NPSLE) and brain magnetic resonance imaging (MRI).Methods:Retrospective analysis of 65 neuropsychiatric lupus patients with brain MRI and clinical data from Peking University Third Hospital from January 2006 to October 2016, which was classified by rheumatologist, neurologists, and radiologists based on their brain MRI findings. The correlation between brain MRI findings and clinical manifestations was analyzed.Results:The characteristics of the brain MRI of the 65 patients were divided into 6 categories: 16 cases (25%) with demyelination in the white matter, 15 cases (23%) with cerebrovascular disease, including 4 cases (6%) with large vascular disease and 11 cases (17%) with small vessel disease, 4 cases (6%) with inflammation, 4 cases (6%) with edema, 13 cases (20%) with multiple manifestation coexistence, and 13 cases (20%) without any abnormality. Except for 4 cases of brain MRI with edema, the clinical manifestations were only epileptic seizures, other patients had complex and diverse clinical manifestations, including epileptic seizures, lupus-like headaches, mental symptoms, blurred vision, peripheral neuropathy and disturbance of consciousness. The incidence of epileptic seizures in patients with edema of MRI is significantly higher than that of other patients, and the therapeutic response time is the shortest.Conclusion:Multidisciplinary collaboration divides the MRI findings of neuropsychiatric lupus patients into six categories. This classification method helps clinicians to predict and intervene early possible neuropsychiatric symptoms to guide clinical treatment.

Key words: Lupus vasculitis,central nervous system, Magnetic resonance imaging, Clinical symptoms

中图分类号:

R593.24

常军英,郑梅,刘颖,刘蕊,张警丰,邓晓莉. 多学科协作对神经精神狼疮磁共振成像特点的分类[J]. 北京大学学报（医学版）, 2018, 50(6): 1009-1013.

Jun-ying CHANG,Mei ZHENG,Ying LIU,Rui LIU,Jing-feng ZHANG,Xiao-li DENG. Multidisciplinary classification of magnetic resonance imaging features of neuropsychiatric lupus[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 1009-1013.

图/表 2

表1

头颅MRI与临床表现及治疗转归的对应关系"

MRI results	MRI manifestation	Clinical manifestation	Treatment	Treatment response time, median (quartile)	Prognosis
Edema (n=4)	PRES	Epilepsy	(1)Intrathecal DXM+ MTX; (2) MP+MMF+ Carbamazepine+Pheno- barbital	3.50 (3.00, 11.50)	No recurrence
Demyelination (n=16)	Multiple point-like demyelination	Psychiatric symptoms, convulsions, headache, peripheral neuropathy, disturbance of consciousness, lethargy with blurred vision, headache with speech disorder, headache with blurred vision	(1)Intrathecal DXM+ MTX; (2) MMF	19.00 (15.00, 26.50)^*	Recurrence in 1 cases
Vascular lesion (n=15)	(1)Multiple vascular infarction; (2) watershed cerebral infarction; (3) middle cerebral artery blood supply area embolization; (4) old lacunar infarctions; (5) thalamic infarction	Headache, left limb weakness, slurred speech, psychiatric symptoms, peri- pheral neuropathy, head- ache with blurred vision, right limb weakness, epilepsy	(1)Intrathecal DXM+ MTX; (2) MP+CTX+MMF+HCQ+Anticoagulation+Carbamazepine	15.00 (14.00, 20.00)^*	Recurrence in 2 cases
Inflammation (n=4)	Inflammation	Unclear speech with weak limbs epilepsy, lethargy, blurred vision	MP+MMF+HCQ	15.00 (12.00, 19.50)	No recurrence
Multiple coexistence (n=13)	(1)Demyelination+lacunar infarctions; (2)lacunar infarctions+edema; (3)PRES+a small amount of inflammatory signal	Numbness of both lower extremities, headache, vision loss, convulsions, mental symptoms, head- ache with convulsions, difficulty in articulation, convulsions and decreased muscle strength in both lower extremities	(1)Intrathecal DXM+MTX; (2) MP+CTX+MMF+CsA+AZA+Anticoagulation+Sodium valproate+Olanzapine	15.00 (13.50, 17.50)	Recurrence in 3 cases
No abnormality (n=13)	No abnormality	Epilepsy, speech disorder, headache, mental symp- toms, convulsions with psychiatric symptoms, mental symptoms with numbness of both lower extremities, mental disorders with confusion	(1)Intrathecal DXM+MTX; (2) MP+MMF+HCQ+Olanzapine+Carbamazepine+Mesenchymal stem cells transfusion	13.00 (9.00, 14.50)^#	No recurrence

表1

图1

参考文献 23

[1]	Ainiala H, Loukkola J, Peltola J , et al. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus[J]. Neurology, 2001,57(3):496-500. doi: 10.1212/WNL.58.12.1867 pmid: 12084902
[2]	Brey RL, Holliday SL, Saklad AR , et al. Neuropsychiatric syndromes in lupus: prevalence using standardized definitions[J]. Neurology, 2002,58(8):1214-1220. doi: 10.1212/WNL.58.8.1214
[3]	Jonsen A, Bengtsson AA, Nived O , et al. Outcome of neuropsychiatric systemic lupus erythematosus within a defined Swedish population: increased morbidity but low mortality[J]. Rheumatology (Oxford), 2002,41(11):1308-1312. doi: 10.1097/00003072-199902000-00007 pmid: 12422005
[4]	Sanna G, Bertolaccini ML, Cuadrado MJ , et al. Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies[J]. J Rheumatol, 2003,30(5):985-992.
[5]	Afeltra A, Garzia P, Mitterhofer AP , et al. Neuropsychiatric lupus syndromes: relationship with antiphospholipid antibodies[J]. Neurology, 2003,61(1):108-110. doi: 10.1212/01.WNL.0000058904.94330.A7 pmid: 12847168
[6]	Hanly JG, Mccurdy G, Fougere L , et al. Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance[J]. J Rheumatol, 2004,31(111):2156-2162. doi: 10.1016/j.jbspin.2004.07.009 pmid: 15517627
[7]	Mikdashi J, Handwerger B . Predictors of neuropsychiatric damage in systemic lupus erythematosus: data from the Maryland lupus cohort[J]. Rheumatology, 2004,43(12):1555-1560. doi: 10.1093/rheumatology/keh384 pmid: 15342927
[8]	Zhou HQ, Zhang FC, Tian XP , et al. Clinical features and outcome of neuropsychiatric lupus in Chinese: analysis of 240 hospitalized patients[J]. Lupus, 2008,17(2):93-99. doi: 10.1177/0961203307085671 pmid: 18250131
[9]	Bultink IE, Turkstra F, Dijkmans BA , et al. High prevalence of unemployment in patients with systemic lupus erythematosus: association with organ damage and health-related quality of life[J]. J Rheumatol, 2008,35(6):1053-1057. doi: 10.1097/RHU.0b013e3181778cb5 pmid: 18381792
[10]	Hanly JG, Su L, Farewell V , et al. Prospective study of neuropsychiatric events in systemic lupus erythematosus[J]. J Rheumatol, 2009,36(71):1449-1459. doi: 10.3899/jrheum.081133 pmid: 19447937
[11]	Briani C, Lucchetta M, Ghirardello A , et al. Neurolupus is associated with anti-ribosomal P protein antibodies: an inception cohort study[J]. J Autoimmun, 2009,32(2):79-84. doi: 10.1016/j.jaut.2008.12.002 pmid: 19171463
[12]	Gonzalez LA, Pons-Estel GJ, Zhang J , et al. Time to neuropsychiatric damage occurrence in LUMINA: a multi-ethnic lupus cohort[J]. Lupus, 2009,18(9):822-830. doi: 10.1177/0961203309104392
[13]	The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes[J]. Arthritis Rheum, 1999,42(4):599-608. doi: 10.1002/(ISSN)1529-0131
[14]	Benseler SM, Silverman ED . Neuropsychiatric involvement in pe-diatric systemic lupus erythematosus[J]. Lupus, 2007,16(8):564-571. doi: 10.1177/0961203307078971 pmid: 17711889
[15]	Ainiala H, Dastidar P, Loukkola J , et al. Cerebral MRI abnormalities and their association with neuropsychiatric manifestations in SLE: a population-based study[J]. Scand J Rheumatol, 2005,34(5):376-382. doi: 10.1080/03009740510026643 pmid: 16234185
[16]	Peterson PL, Axford JS, Isenberg D . Imaging in CNS lupus[J]. Best Pract Res Clin Rheumatol, 2005,19(5):727-739. doi: 10.1016/j.berh.2005.04.001
[17]	Hanly JG, Walsh NM, Sangalang V . Brain pathology in systemic lupus erythematosus[J]. J Rheumatol, 1992,19(5):732-741. pmid: 1613703
[18]	Kiss E, Shoenfeld Y . Are anti-ribosomal P protein antibodies relevant in systemic lupus erythematosus?[J]. Clin Rev Allergy Immunol, 2007,32(1):37-46. doi: 10.1007/BF02686080 pmid: 17426359
[19]	王元, 顾越英, 鲍春德 . 神经精神狼疮的诊断和治疗[J]. 中华风湿病学杂志, 2004,8(4):230-233. doi: 10.3760/j:issn:1007-7480.2004.04.010
[20]	Govoni M, Castellino G, Padovan M , et al. Recent advances and perspective in neuroimaging in neuropsychiatric systemic lupus erythematosus[J]. Lupus, 2004,13(3):149-158. doi: 10.1191/0961203304lu1000rr
[21]	杨燕, 刘秀梅, 孙美珍 . 神经精神性狼疮的临床表现和MRI特点分析[J]. 中国神经免疫学和神经病学杂志, 2011,18(4):287-289.
[22]	Sarbu N, Alobeidi F, Toledano P , et al. Brain abnormalities in newly diagnosed neuropsychiatric lupus: systematic MRI approach and correlation with clinical and laboratory data in a large multicenter cohort[J]. Autoimmun Rev, 2015,14(2):153-159. doi: 10.1016/j.autrev.2014.11.001 pmid: 25461835
[23]	Luyendijk J, Steens SC, Ouwendijk WJ , et al. Neuropsychiatric systemic lupus erythematosus: lessons learned from magnetic resonance imaging[J]. Arthritis Rheum, 2011,63(3):722-732. doi: 10.1002/art.30157 pmid: 21360502

相关文章 15

[1]	吴一凡,张晓圆,任爽,玉应香,常翠青. 基于磁共振的青年男性股四头肌的测量和评估[J]. 北京大学学报（医学版）, 2021, 53(5): 843-849.
[2]	盛荟,梁磊,周童亮,贾彦兴,王彤,袁兰,韩鸿宾. 光磁双模态探针钆-[4,7-双-羧甲基-10-(2-荧光素硫脲乙基)-1,4,7,10-四氮杂环十二烷-1-基]-乙酸络合物合成方法的改进[J]. 北京大学学报（医学版）, 2020, 52(5): 959-963.
[3]	赵世明,杨铁军,许春苗,郭孝峰,马永康,陈学军,李祥,何朝宏. 3.0T磁共振成像在接受过经尿道膀胱肿瘤切除术膀胱癌中诊断肌层浸润的应用[J]. 北京大学学报（医学版）, 2020, 52(4): 701-704.
[4]	宋宇,韩鸿宾,杨军,王艾博,和清源,李媛媛,赵国梅,高亚娟,王睿,韩易兴,刘爱连,宋清伟. 脑对流增强给药对老年大鼠脑细胞外间隙微观结构的影响[J]. 北京大学学报（医学版）, 2020, 52(2): 362-367.
[5]	吴静云,米悦,刘水,姚林,唐琦,何志嵩,王霄英. MRI对肾细胞癌静脉瘤栓侵犯下腔静脉壁的术前评估[J]. 北京大学学报（医学版）, 2019, 51(4): 673-677.
[6]	许力,胡明洁,李玉玉,屈洪党,钱伟东,刘晓林. 圆锥马尾部黏液乳头型室管膜瘤继发中枢神经系统表面铁沉积症1例报道及文献复习[J]. 北京大学学报（医学版）, 2019, 51(4): 769-774.
[7]	王伟,侯进,黄文强. 运动导致兴奋脑区组织液流动一过性加速[J]. 北京大学学报（医学版）, 2019, 51(2): 206-209.
[8]	张晓慧,邓雪蓉,李凡,朱颖,张卓莉. 系统性红斑狼疮合并可逆性后部脑病综合征1例[J]. 北京大学学报（医学版）, 2018, 50(6): 1102-1107.
[9]	王欢，覃小雅，李子圆，郑卓肇，范田园. 柠檬酸修饰的超顺磁性氧化铁纳米粒的制备及表征[J]. 北京大学学报(医学版), 2018, 50(2): 340-346.
[10]	李昀倩，盛荟，梁磊，赵越，李怀业，白宁，王彤，袁兰，韩鸿宾. 光磁双模态分子探针Gd-DO3A-EA-FITC在脑组织间隙成像分析中的应用[J]. 北京大学学报(医学版), 2018, 50(2): 221-225.
[11]	赵越，李昀倩，李怀业，李玉亮，刘兰祥，袁兰，张殊佳，韩鸿宾. 荧光及磁示踪法观测脑组织液的引流分区特征[J]. 北京大学学报(医学版), 2017, 49(2): 303-309.
[12]	郑艺明，李文竹，王朝霞，张巍，吕鹤，肖江喜，袁云. 类似内收肌附丽病的抗肌萎缩蛋白病骨骼肌磁共振成像特点[J]. 北京大学学报(医学版), 2016, 48(5): 846-849.
[13]	郑艺明，杜婧，李文竹，王朝霞,张巍，肖江喜，袁云. 磁共振肌肉脂肪化色阶直方图评估法的临床应用[J]. 北京大学学报(医学版), 2016, 48(5): 830-834.
[14]	张晶,左盼莉，程克斌，于爱红，程晓光. 动态增强磁共振成像用于肌骨系统肿瘤定性诊断的可行性[J]. 北京大学学报(医学版), 2016, 48(2): 287-291.
[15]	李怀业, 赵越, 左龙, 傅瑜, 李楠, 袁兰, 张殊佳, 韩鸿宾. 光、磁分子探针在脑组织间隙内的扩散分布规律[J]. 北京大学学报(医学版), 2015, 47(4): 667-673.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed