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

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