【狼疮合并可逆性后部脑病综合征…
狼疮合并可逆性后部脑病综合征的危险因素是高血压、肾受累和淋巴细胞减少等
作者: Merayo-Chalico J,et al. 翻译: 艾伯维医学部元华龙 发布者：于若寒，校正：刘佩玲
摘要:可逆性后部脑病综合征是系统性红斑狼疮（systemic lupus erythematosus，SLE）的一个众所周知但罕见的并发症（＜1%），目前流行病学数据严重不足。本研究旨在探讨潜在未知的危险因素。
研究对象和方法：本研究是一项多中心、回顾性病例对照研究，共纳入墨西哥1999～2014年间168例患者，其中可逆性后部脑病综合征事件77次。具体如下：SLE合并可逆性后部脑病综合征患者43例，出现可逆性后部脑病综合征 48次；SLE不合并可逆性后部脑病综合征患者96例；可逆性后部脑病综合征不合并SLE患者29例。满足美国风湿病学会SLE分类标准4条以上即诊断SLE，可逆性后部脑病综合征定义为有可逆的神经系统症状和MRI影像学改变。
结果：SLE合并可逆性后部脑病综合征的患者更年轻，癫痫发作是最常见的临床表现（81%），其中18%MRI上有典型的枕骨部位改变。SLE患者出现可逆性后部脑病综合征的独立危险因素有：高血压（OR，16.3；95%CI，4.03～65.8）、肾脏受累（OR，6.65；95%CI，1.24～35.6）、淋巴细胞减少（OR，5.76；95%CI，1.36～24.4）、SLEDAI评分≥6分（OR，1.11；95%CI，1.01～1.22），以及发病时年纪轻（OR，0.86；95%CI，0.81～0.91；P＜0.001）。此外，血脂异常也被认为与SLE合并可逆性后部脑病综合征相关（OR，10.6；95%CI，1.17～96.4）。
结论：本研究报道, SLE合并RRES患者的例数目前最多。研究证实了已知的可逆性后部脑病综合征的危险因素，并发现了2个尚未报道的危险因素（淋巴细胞减少和血脂异常），提示内皮功能紊乱可能是SLE患者发生可逆性后部脑病综合征的一个关键因素。
附原文：Abstract BACKGROUND:Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in patients (<1%) with systemiclupus erythematosus (SLE). However, current epidemiological data are quite scant. The aim of the present study was to describe potentially unrecognised risk factors. PATIENTS AND METHODS:We performed a multicentre, retrospective case-control study in Mexico between 1999 and 2014. We included a total of 168 patients who accounted for 77 episodes of PRES, as follows: SLE/PRES, 43 patients with 48 episodes; SLE without PRES, 96 patients; and PRES without SLE, 29 patients. SLE diagnosis was considered when patients fulfilled ≥4 American College of Rheumatology criteria. PRES was defined by reversible neurological manifestations and MRI changes.RESULTS:Patients with SLE/PRES were younger, presented with seizures as the most common manifestation (81%) and 18% had the typical occipital MRI finding. Hypertension (OR=16.3, 95% CI 4.03 to 65.8), renal dysfunction (OR=6.65, 95% CI 1.24 to 35.6), lymphopenia (OR=5.76, 95% CI 1.36 to 24.4), Systemic Lupus Erythematosus Activity Index ≥ 6 points (OR=1.11, 95% CI 1.01 to 1.22) and younger age (OR=0.86, 95% CI 0.81 to 0.91, p<0.001) were independent risk factors for development of PRES in SLE. Furthermore, dyslipidemia also characterised the association between PRES and SLE (OR=10.6, 95% CI 1.17 to 96.4).CONCLUSIONS:This is the largest reported series of patients with SLE and PRES. We were able to corroborate the known risk factors for of PRES, and found two previously undescribed factors (lymphopenia and dyslipidemia), which suggests that endothelial dysfunction is a key element in PRES pathogenesis in lupus patients.
引自：Merayo-Chalico，J，et al. Clinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case-control study. J Neurol Neurosurg Psychiatry. 2016 Mar;87(3):287-94.
作者: Merayo-Chalico J,et al. 翻译: 艾伯维医学部元华龙
摘要:可逆性后部脑病综合征是系统性红斑狼疮（systemic lupus erythematosus，SLE）的一个众所周知但罕见的并发症（＜1%），目前流行病学数据严重不足。本研究旨在探讨潜在未知的危险因素。
研究对象和方法：本研究是一项多中心、回顾性病例对照研究，共纳入墨西哥1999～2014年间168例患者，其中可逆性后部脑病综合征事件77次。具体如下：SLE合并可逆性后部脑病综合征患者43例，出现可逆性后部脑病综合征 48次；SLE不合并可逆性后部脑病综合征患者96例；可逆性后部脑病综合征不合并SLE患者29例。满足美国风湿病学会SLE分类标准4条以上即诊断SLE，可逆性后部脑病综合征定义为有可逆的神经系统症状和MRI影像学改变。
结果：SLE合并可逆性后部脑病综合征的患者更年轻，癫痫发作是最常见的临床表现（81%），其中18%MRI上有典型的枕骨部位改变。SLE患者出现可逆性后部脑病综合征的独立危险因素有：高血压（OR，16.3；95%CI，4.03～65.8）、肾脏受累（OR，6.65；95%CI，1.24～35.6）、淋巴细胞减少（OR，5.76；95%CI，1.36～24.4）、SLEDAI评分≥6分（OR，1.11；95%CI，1.01～1.22），以及发病时年纪轻（OR，0.86；95%CI，0.81～0.91；P＜0.001）。此外，血脂异常也被认为与SLE合并可逆性后部脑病综合征相关（OR，10.6；95%CI，1.17～96.4）。
结论：本研究报道, SLE合并RRES患者的例数目前最多。研究证实了已知的可逆性后部脑病综合征的危险因素，并发现了2个尚未报道的危险因素（淋巴细胞减少和血脂异常），提示内皮功能紊乱可能是SLE患者发生可逆性后部脑病综合征的一个关键因素。
附原文：Abstract BACKGROUND:Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in patients (<1%) with systemiclupus erythematosus (SLE). However, current epidemiological data are quite scant. The aim of the present study was to describe potentially unrecognised risk factors. PATIENTS AND METHODS:We performed a multicentre, retrospective case-control study in Mexico between 1999 and 2014. We included a total of 168 patients who accounted for 77 episodes of PRES, as follows: SLE/PRES, 43 patients with 48 episodes; SLE without PRES, 96 patients; and PRES without SLE, 29 patients. SLE diagnosis was considered when patients fulfilled ≥4 American College of Rheumatology criteria. PRES was defined by reversible neurological manifestations and MRI changes.RESULTS:Patients with SLE/PRES were younger, presented with seizures as the most common manifestation (81%) and 18% had the typical occipital MRI finding. Hypertension (OR=16.3, 95% CI 4.03 to 65.8), renal dysfunction (OR=6.65, 95% CI 1.24 to 35.6), lymphopenia (OR=5.76, 95% CI 1.36 to 24.4), Systemic Lupus Erythematosus Activity Index ≥ 6 points (OR=1.11, 95% CI 1.01 to 1.22) and younger age (OR=0.86, 95% CI 0.81 to 0.91, p<0.001) were independent risk factors for development of PRES in SLE. Furthermore, dyslipidemia also characterised the association between PRES and SLE (OR=10.6, 95% CI 1.17 to 96.4).CONCLUSIONS:This is the largest reported series of patients with SLE and PRES. We were able to corroborate the known risk factors for of PRES, and found two previously undescribed factors (lymphopenia and dyslipidemia), which suggests that endothelial dysfunction is a key element in PRES pathogenesis in lupus patients.
引自：Merayo-Chalico，J，et al. Clinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case-control study. J Neurol Neurosurg Psychiatry. 2016 Mar;87(3):287-94.
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