Diagnosis and management of patients with neuropsychiatric systemic lupus erythematosus (NPSLE)
Diagnosis and management of patients with neuropsychiatric systemic lupus erythematosus (NPSLE)
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DOI：
10.1053/berh.2001.0223
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发表时间：
2002-04-01
影响因子：
5.2
通讯作者：
Brey, RL
中科院分区：
文献类型：
--
作者：
Hermosillo-Romo, D;Brey, RL
神经精神系统性红斑狼疮（NPSLE）涉及广泛的局灶性和弥漫性中枢和外周神经系统疾病，影响高达75%的SLE患者。NPSLE可在SLE过程中的任何时间发生，甚至在未检测到SLE疾病活动的时期，并且可能由多种因素引起，包括自身抗体产生、微血管病变和促炎性细胞因子。NPSLE诊断的核心问题是目前的神经精神症状是否是由于SLE介导的器官功能障碍，感染，药物副作用或代谢异常（如尿毒症），或由于无关的条件。只有在排除这些次要原因后，才能作出NPSLE的诊断推断。没有一个单一的诊断工具，具体到NPSLE，临床诊断印象必须基于免疫血清学测试，功能和/或结构神经影像学和标准化的神经，流变学，精神和神经心理学评估的结合使用。NPSLE的管理包括对症和/或免疫抑制治疗策略，这取决于具体的神经精神症状以及这些症状是否发生在SLE疾病活动性发作的情况下。
Neuropsychiatric systemic lupus erythematosus (NPSLE) involves a wide range of focal and diffuse central and peripheral nervous system disorders and affects up to 75% of SLE patients. NPSLE can occur any time in the course of SLE, even during periods in which no SLE disease activity is detected, and is likely to be caused by multiple factors, including autoantibody production, microvasculopathy and pro-inflammatory cytokines. Central to the diagnosis of NPSLE is the question of whether the presenting neuropsychiatric symptoms are due to SLE-mediated organ dysfunction, infection, medication side-effects or metabolic abnormalities (e.g. uraemia), or are due to an unrelated condition. The diagnostic inference of NPSLE can be made only after these secondary causes have been excluded. There is no one single diagnostic tool specific to NPSLE, and clinical diagnostic impressions must be based on the combined use of immunoserological testing, functional and/or structural neuroimaging and standardized neurological, rheumatological, psychiatric and neuropsychological assessments. The management of NPSLE includes symptomatic and/or immunosuppressive treatment strategies depending on the specific presenting neuropsychiatric symptoms and whether these occur in the setting of an SLE disease activity flare.