系统性红斑狼疮合并中枢神经系统感染34例临床分析

摘要

目的 研究分析系统性红斑狼疮(SLE)合并中枢神经系统感染的临床表现.方法 回顾性分析2001年1月至2011年12月石家庄平安医院34例SLE合并中枢神经系统感染患者临床资料,提出临床特征及其相关危险因素.结果 34例SLE合并中枢神经系统感染,发生率为1.44％；其中结核性脑膜炎25例(73.53％),新型隐球菌脑膜炎7例(20.59％),病毒性脑膜炎2例(5,88％).给予内科常规治疗,25例结核性脑膜炎痊愈21例,死亡4例；7例隐球菌脑膜炎痊愈3例,死亡4例.病毒性脑膜炎痊愈1例,死亡1例.本文SLE合并中枢神经系统感染34例中总共死亡9例(26.47％).全部患者在诊断前均经过糖皮质激素治疗,28例患者应用较大剂量激素治疗,18例患者联合免疫抑制剂治疗.SLE合并中枢神经系统感染的临床特点主要为高热、头痛及意识障碍；狼疮活动度评分(SLEDAI)平均9±3分.脑脊液检查发现糖和氯化物降低明显.结论 ①系统性红斑狼疮合并中枢神经系统感染以结核性脑膜炎最常见；②肾上腺皮质激素、免疫抑制剂的应用是SLE合并感染的危险因素；③SLE合并中枢神经系统感染与狼疮活动度无关,而神经精神狼疮多发生于狼疮高度活动期,SLEDAI评分对二者鉴别诊断有意义；④狼疮合并中枢神经系统感染以高热、头痛及颅内压增高为主要表现,反复腰穿脑脊液检查对SLE合并中枢神经系统感染的诊断和判断预后有重要价值.%Objective Research and analysis the clinical manifestations of systemic lupus erythematosus complicated with central nervous system infection, to raise awareness of the disease and the level of diagnosis and treatment. Methods Through the retrospective analysis of clinical data of the 34 cases of patients with SLE complicated with central nervous system infection in Shijiazhuang Ping'an hospital from January 2001 to December 2011 , presenting clinical features and related risk factors. Results There were 34 cases with central nervous system infection in 2356 SLE patients ( 1. 44% ). There were 25 cases tuberculous meningitis among them (73. 53% ), cryptococcal meningitis 7 cases ( 20. 59% ) , viral meningitis 2 cases ( 5. 88% ). All the patient were given the conventional medical treatment. In 25 cases of tuberculous meningitis in 21 cases were cured, 4 cases died,7 cases of cryptococcal meningitis 3 cases were cured, 4 cases died,Disease of brain 1 case was cured, 1 cases death . Total 9 cases died( 26.47%). All the patients were treated with glucocorticoid treatment,28 eases with larger hormone therapy,8 cases with combined immunosuppressive therapy. The main clinical features were headache, fever and disturbance of consciousness. The average SLEDAI score was(9 ±3). Examination of cerebrospinal fluid find glucose and chloride decreased obviously. Conclusion ①The most common SLE complicated with central nervous system infection is tuberculosis meningitis; ②The use of corticosteroids, and immunosuppressive agents is the risk factors of SLE complicated with infection. ③SLE complicated with central nervous system infection related to lupus activity , but neuropsychiatnc lupus erythematosus height occur in SLE active period. The SLEDAI score is meaningful on the two differential diagnosis. ④The main clinical manifestation of SLE with central nervous system infection are high fever,headache, increased intracranial pressure. Repeated cerebrospinal fluid examinations for SLE complicated with infection of central nervous system in the diagnosis and prognostic value.