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目的对神经精神狼疮患者的诊断和治疗进行临床总结。方法对83例SLE患者进行回顾性分析总结。42例为神经精神狼疮(NPSLE)患者;41例为无临床神经精神症状的SLE对照组。对两组病人实验室检查,包括血液:细胞计数、电解质、肝肾功能、血糖、血脂、血沉;免疫学检测:补体、抗dsDNA抗体、可提取的核抗原(ENA)、间接荧光抗核抗体(IFANA)、抗磷脂抗体等;尿:尿常规、24h尿蛋白;脑脊液:常规、生化、脑脊液压力、细菌、霉菌学检查、免疫球蛋白检测;影像学检查:脑电图(EEG)、脑CT、脑核磁共振。治疗:对于昏迷、癫痫大发作、急性意识障碍的重症NPSLE患者治疗的甲泼尼龙(MP)起始剂量约200~500mg/d;对于一般认知障碍、磷脂抗体综合征、局灶性NPSLE(FNPSLE)的泼尼松剂量约1~2mg·kg-1·d-1。当MP剂量渐减至100mg/d应及时适当应用环磷酰胺(CTX)、甲氨蝶呤(MTX)、硫唑嘌呤(AZA)等免疫抑制剂。统计学分析:Fisher’s精确试验和t检验。结果临床症状方面,NPSLE和SLE对照组比较,面部红斑(71%∶44%)和皮肤/胃肠道血管炎的发生率(67%∶27%)差异有显著性(P<0.001)。血清学检测,两组比较,仅抗磷脂抗体(aCL)和/或抗β2糖蛋白1(β2GP1)差异有显著性,其发生率分别为43%和22%(P<0.05)。42例NPSLE患者,其中33例为弥漫性NPSLE(DNPSLE),9例为F
Objective To summarize the diagnosis and treatment of neuropathic lupus patients. Methods 83 cases of SLE patients were retrospectively analyzed and summarized. 42 cases were patients with neuropathic lupus (NPSLE) and 41 cases were SLE control group without clinical neuropsychiatric symptoms. Laboratory tests on two groups of patients included blood: cell count, electrolytes, liver and kidney function, blood glucose, lipids, erythrocyte sedimentation rate; immunological tests: complement, anti-dsDNA antibody, extractable nuclear antigen (ENA), indirect fluorescent anti-nuclear antibody (IFANA), anti-phospholipid antibodies, etc .; Urine: Urine routine, 24h urinary protein; Cerebrospinal fluid: conventional, biochemical, cerebrospinal fluid pressure, bacteria, mycology, immunoglobulin; imaging studies: EEG, CT, brain nuclear magnetic resonance. Treatment: The onset dose of methylprednisolone (MP) is approximately 200-500 mg / day for patients with severe NPSLE who have a coma, major epileptic seizure, or acute disturbance of consciousness. For general cognitive disorders, phospholipid antibody syndrome, focal NPSLE ( FNPSLE) prednisone dose of about 1 ~ 2mg · kg-1 · d-1. When the dose of MP is gradually reduced to 100mg / d, immunosuppressants such as cyclophosphamide (CTX), methotrexate (MTX) and azathioprine (AZA) should be applied in time. Statistical Analysis: Fisher’s exact test and t test. Results In clinical symptoms, there was a significant difference (P <0.001) between facial erythema (71%: 44%) and skin / gastrointestinal vasculitis (67%: 27%) in NPSLE and SLE controls. Serological tests showed that there was significant difference between anti-phospholipid antibodies (aCL) and / or anti-β2 glycoprotein 1 (β2GP1) in both groups, with a prevalence of 43% and 22%, respectively (P <0.05). Of 42 patients with NPSLE, 33 were diffuse NPSLE (DNPSLE) and 9 were F