Neuropsychiatric lupus: new mechanistic insights and future treatment directions.
Neuropsychiatric lupus: new mechanistic insights and future treatment directions.
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DOI：
10.1038/s41584-018-0156-8
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Putterman C
中科院分区：
文献类型：
--
作者：
Schwartz N;Stock AD;Putterman C
系统性红斑狼疮（SLE）患者常表现出中枢神经系统（CNS）受累的症状，称为神经精神性SLE（NPSLE）。SLE的CNS表现是多样的，并且具有广泛的严重程度和预后意义。NPSLE患者通常表现为非特异性症状，如头痛和认知障碍，但也可能出现破坏性特征，如记忆丧失，癫痫发作和中风。NPSLE的一些特征，特别是与凝血功能障碍相关的特征，已经得到了表征，并且可以使用循证治疗算法。然而，NPSLE的认知和情感表现仍然知之甚少。各种免疫效应物已被评估为其发病机制的贡献者，包括脑反应性自身抗体、细胞因子和细胞介导的炎症。其他脑内因素（如常驻小胶质细胞，血脑屏障和其他神经血管界面）是NPSLE的重要促进因素。然而，到目前为止，还没有发现统一的模型来解释NPSLE的发病机制，这表明这种疾病有多个因素，也许有几个不同的病因。这种异质性给传统上依赖经验判断为NPSLE患者选择治疗方式的临床医生带来了挑战。对SLE这种表现的进一步了解可能会为管理这种疾病提供进一步的选择。
Patients with systemic lupus erythematosus (SLE) frequently show symptoms of central nervous system (CNS) involvement, termed neuropsychiatric SLE (NPSLE). The CNS manifestations of SLE are diverse and have a broad spectrum of severity and prognostic implications. Patients with NPSLE typically present with nonspecific symptoms, such as headache and cognitive impairment, but might also experience devastating features, such as memory loss, seizures and stroke. Some features of NPSLE, in particular those related to coagulopathy, have been characterized and an evidence-based treatment algorithm is available. The cognitive and affective manifestations of NPSLE, however, remain poorly understood. Various immune effectors have been evaluated as contributors to its pathogenesis, including brain-reactive autoantibodies, cytokines and cell-mediated inflammation. Additional brain-intrinsic elements (such as resident microglia, the blood–brain barrier and other neurovascular interfaces) are important facilitators of NPSLE. As yet, however, no unifying model has been found to underlie the pathogenesis of NPSLE, suggesting that this disease has multiple contributors and perhaps several distinct aetiologies. This heterogeneity presents a challenge for clinicians who have traditionally relied on empirical judgement in choosing treatment modalities for patients with NPSLE. Improved understanding of this manifestation of SLE might yield further options for managing this disease.
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影响因子：
5.5
作者：
Bortoluzzi, Alessandra;Scire, Carlo Alberto;Govoni, Marcello
通讯作者：
Govoni, Marcello
影响因子：
64.8
作者：
Bialas, Allison R.;Presumey, Jessy;Carroll, Michael C.
通讯作者：
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DOI：
10.1126/science.1252945
发表时间：
2014-10-03
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
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通讯作者：
Schwartz M
影响因子：
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作者：
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通讯作者：
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影响因子：
9.9
作者：
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通讯作者：
Costallat, LTL