Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus
Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus
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DOI：
10.1016/s0002-9343(00)00603-3
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发表时间：
2000-12-01
影响因子：
5.9
通讯作者：
Moutsopoulos, HM
中科院分区：
文献类型：
--
作者：
Karassa, FB;Ioannidis, JPA;Moutsopoulos, HM
目得：我们试图确定的临床结果和神经精神系统性红斑狼疮（SLE）患者的大脑异常的演变的预测因素。对象和方法：32例SLE患者（包括14例抗磷脂综合征）已住院治疗原发性神经精神疾病前瞻性观察至少2年。对住院期间和2年后获得的实验室和临床特征以及磁共振成像（MRI）研究数据进行了评价。我们确定不可逆的或新的MRI变化和临床结果，包括神经精神事件，在follow-up.Results：颅脑MRI扫描入院时异常的26（81%）的32例。抗磷脂综合征患者更可能有局灶性脑白色病变（比值比[OR] = 12，95%置信区间[CI]：2.0 - 72）。2年后，22例（69%）患者的神经精神功能缺损显著改善，6例（19%）稳定，4例（12%）恶化。既往神经精神事件数量与2年时持续性MRI病变（每起事件OR = 4.8，95% CI：1.1 - 21）和不良临床结局（每起事件OR = 4.3，95% CI：1.4 - 13）相关。抗磷脂综合征也预测了不利的临床结果在2年（OR = 11，95%CI：1.7至65）。结论：在SLE患者中，有神经精神疾病，以前的神经精神事件和抗磷脂综合征的不良后果的风险增加。(C)2000年出版，Excerpta Medica，Inc.
PURPOSE: We sought to identify the predictors of clinical outcome and of the evolution of cerebral abnormalities in patients with neuropsychiatric systemic lupus erythematosus (SLE).SUBJECTS AND METHODS: Thirty-two patients with SLE (including 14 with the antiphospholipid syndrome) who had been hospitalized with primary neuropsychiatric disease were observed prospectively for at least 2 years. Laboratory and clinical characteristics and data from magnetic resonance imaging (MRI) studies obtained during the hospitalization and 2 years later were evaluated. We ascertained nonreversible or new MRI changes and clinical outcomes, including neuropsychiatric events, during follow-up.RESULTS: Cranial MRI scans on admission were abnormal in 26 (81%) of the 32 patients. Patients with the antiphospholipid syndrome were more likely to have focal cerebral white matter lesions (odds ratio [OR] = 12, 95% confidence interval [CI]: 2.0 to 72). After 2 years, neuropsychiatric deficits substantially improved in 22 (69%) of the patients, stabilized in 6 (19%), and deteriorated in 4 (12%). The number of prior neuropsychiatric events was associated with persistent MRI lesions (OR = 4.8 per each event, 95% CI: 1.1 to 21) and unfavorable clinical outcome (OR = 4.3 per each event, 95% CI: 1.4 to 13) at 2 years. The antiphospholipid syndrome also predicted an unfavorable clinical outcome at 2 years (OR = Il, 95% CI: 1.7 to 65).CONCLUSIONS: Among patients with SLE who have neuropsychiatric disease, prior neuropsychiatric events and the antiphospholipid syndrome increase the risk of adverse outcomes. (C) 2000 by Excerpta Medica, Inc.